ROOTS OF CLINICAL INTUITION IN COUNSELING:
A QUALITATIVE APPROACH
LAUREN PASQUARELLA DALEY
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
I want to thank my husband, Matthew, for his support, love, and encouragement
throughout my entire doctoral program and particularly while writing this dissertation. He
was my rock to build upon whenever I struggled during my research. His support and
help also gave me the strength and will to finish my research in the times when finishing
did not seem probable. Without his love, motivation and assistance, furnishing this project
would not have been possible.
I also wish to thank my parents, Ron and JoAnn Pasquarella, for instilling a love
of education and a sense of curiosity in me, without which I would never have pursued
I wish to also thank my advisor, Dr. Peter Sherrard, for giving me his support,
encouragement, and freedom to explore a nebulous topic. He gave me the latitude to
discover while also helping me when I got bogged down in the details. Our discussions
inspired me and triggered my own intuition regarding the direction of my research.
Without his guidance and motivation, I would not have finished this project.
I also want to thank my methodologist, Dr. Mirka Koro-Ljungberg for her
patience, understanding, encouragement and assistance throughout writing my
dissertation. I learned a great deal from her during my research and have opened my eyes
to a different point of view about science from working with her. Without her timeliness
in returning my drafts and direction in my study, finishing this dissertation would not
have been possible.
Finally, I wish to thank the remainder of my dissertation committee, Dr. Harry
Daniels, Dr. Mary Fukuyama, and Dr. Paul Schauble for their patience, assistance,
support and understanding while I wrote my dissertation. Without their openness to
discuss a topic such as intuition in a scholarly fashion, I would never have started the
project. Throughout the dissertation, their support and open-mindedness encouraged my
completion of this project.
TABLE OF CONTENTS
ACKNOWLEDGMENTS ................... ......................................................1
FIGURE............................................ ...- -------- --------
ABSTRACT ................... .......................................----------------------V
1 INTRODUCTION ................... ................... ....................................
2 REVIEW OF THE LITERATURE ................... ................... ....................13
3 METHOD ................... ................... ........................................4
Data Collection ................... ................... .....................................5
Sampling ................... ................... ............ ................... ....5
Participants ................... ................... ......................................5
Interview Procedures ................... .....................................................5
Validity and Reliability ................... ................... ...............................6
Data Analysis ................... ................... .......................................6
4 FINDINGS ................... ................... ......................................6
5 IMPL ICATION S & CONCLUSIONS ................... ................... ................ 8 7
A INITIAL INTERVIEW QUESTIONS ................... ................... ................98
B REVISED INTIAL INTERVIEW QUESTIONS ................... ................... .....99
C FOLLOW-UP INTERVIEW QUESTIONS ................... ................... .......1000
D SAMPLE THEORETICAL MEMO ................... ................... .................101
REFERENCES ................... .................. ................... ...................103
BIOGRAPHICAL SKETCH ................... ................... ..............................11
1 Theoretical Model of Clinical Intuition in Counseling ................... ............67
Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
ROOTS OF CLINCIAL INTUITION IN COUNSELING:
A QUALITATIVE APPROACH
Lauren Pasquarella Daley
Chair: Peter A. Sherrard
Major Department: Counselor Education
The purpose of this study was to better define and understand how counselors
make meaning and how counselors use that meaning of their clinical intuition to help
clients by developing a preliminary theory of its use in counseling through a series of
semi-structured interviews with counselors that were analyzed using constructivist
grounded theory methodology.
The scholarly nursing, medical and business literature and the personal
experiences of counselors suggest that using intuition while counseling can benefit the
counseling process and thus benefit the client. However. the way counselors make
meaning of their intuitions and how they use them in practice has not been studied.
Constructivism states that individuals construct meaning of reality and the events
within that reality inside their individual minds. Grounded theory is a qualitative research
method aimed at developing a data-based theory. Using constructivism as my theoretical
foundation and grounded theory as my methodology, I studied two research questions:
how do counselors construct meaning of clinical intuition and how do counselors use the
constructed intuitions to help their clients? I interviewed five counselors with varying
levels of experience and coded the data according to grounded theory methodology. The
theory that emerged from the data is as follows: counselors construct meaning of clinical
intuition as a sense of knowing or awareness about their clients, resulting from the
counseling relationship, that they then communicate to the client, benefiting the
counseling process. The theory incorporates elements of defining what intuition is and
how the counselors receive or recognize it as intuition, the importance and cyclical nature
of the counseling relationship in generating clinical intuition, how counselors
communicate the intuitions to their clients, and also the boundaries and benefits of using
The research confirmed the concept that using clinical intuition while counseling
is beneficial to the counselor and the client. As a result, counseling training programs
should incorporate some aspect of teaching counselors to trust their intuitions so they use
them more regularly. Furthermore, managed care and insurance plans should support
counselors using clinical intuition as it moves the client toward therapeutic change more
The Roots of Clinical Intuition in Counseling: A Qualitative Approach
The ability to receive information from an unknown source has been a point of
psychological contention for many years. From an objectivist perspective, intuition is
often considered a nonsensical idea. However, with the surging public interest in these
topics, the various anecdotes describing personal experiences with such insights, and the
investigation of intuition/clinical intuition in the medical, nursing and business fields,
there is a trend toward examining these constructs from a research-based perspective.
Although the amount of research on intuition is growing, there have been relatively few
studies of the role intuition (clinical intuition) plays in counseling and for counselors.
Most of the intuition research has been conducted in the last fifty to sixty years.
However, interest in intuition is not new. Those able to "predict" the future have offered
guidance to seekers throughout the history of humankind. Intuition is not just the idea
that one can predict the future. Intuition is also the sense of knowing something before
having hard evidence for it. Additionally, Eastern medicine and native traditions have
long believed that warnings about disease and crisis can come through intuitive
knowledge (Sue & Sue, 1999). This belief that before any physical manifestation of
disease occurs, the mind-body-spirit sends warnings through intuition and dreams is
gaining limited acceptance in Western medicine, psychology, and counseling (Barasch,
Despite the long history describing intuition, the idea that everyone has this
intuitive ability is a relatively novel idea. Many contemporary authors believe that
intuition is an innate, natural, and important skill every person has and can develop
further (Day, 1996; De Becker, 1997; Emery, 1999; Faiver, McNally, & Nims, 2000;
Klein, 2003; Naparstek, 1997; Schulz, 1998; Shirley & Lagan-Fox, 1996; Vaughan,
1979). Not only is intuition viewed as a natural skill, but it is also considered by some to
be the voice of the soul, connecting the mind-body-spirit to its higher self (Naparstek,
1997: Zukay, I989).
This study will attempt to further describe and understand the phenomenon of
clinical intuition in counseling by interviewing counselors and analyzing the interviews
using grounded theory (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978;
Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998).
Definition of Intuition
What exactly is intuition? Many authors define intuition in different ways.
However, most definitions of intuition state that it is an unconscious, non-rational means
of receiving information. Popular culture and academic authors, although using different
language, often describe intuition in similar terms.
From a pop culture perspective, Day (1996) defines intuition as "a nonlinear,
nonempirical process of gaining and interpreting information in response to questions"'
(p. 83). Intuition is comprised of three primary modalities: precognition (knowing future
events), the intuitive experience (knowing current events), and dreams (either
precognitive or intuitive). Day (1996) noted that we may perceive information from
intuition through clairvoyance (seeing), clairsentience (feeling), and clairaudience
(hearing). Goldberg (1983) clarifies further that although intuition is often linked to the
psychic phenomena of precognition, ESP, telepathy, clairvoyance, and clairaudience,
only precognition and ESP are truly intuition. Goldberg (1983) believes that the intuition
of precognition occurs when people pick up information not available through our
ordinary five senses and is by definition extrasensory.
Other contemporary pop culture authors define intuition as "a clear knowing
without being able to explain how one knows, or knowledge gained without logical or
rational thought. Intuition is the receipt of information from a nonphysical database"
(Emery, 1999, p. 5); and/or "when we directly perceive facts outside the range of the
usual five senses and independently of any reasoning process" (Schulz, 1998, p. 19).
Naparstek (1997) describes intuition as "psi [her italics]--the knowing and sensing that
overleaps logic, analysis, and rational thought and just shows up. This is called intuition,
ESP. psychic ability, telepathy, clairvoyance, high sense perception, and paranormal
intelligence" (p. I5).
Scholarly definitions of intuition include similar concepts. One definition of
intuition "implies rapid understanding or knowledge without the conscious use of
reasoning" (Bowers, Regehr, Balthazard, & Parker, I990, p. 72). Another author
describes intuition as "[a] hunch .. events or processes that occur in the absence of
conscious mental will .. a bridging function that brings information into awareness in
the absence of directed mental activity" (Isenman, 1997, pp. 395-396). Hall (2002)
describes intuition as "cognitive 'short-circuiting' where a decision is reached even
though the reasons for the decisions cannot be easily described" (p. 216). In addition to
defining intuition as a means of obtaining and processing information, intuition is also
one of the perceptive functions of Jung's theory of personality type that reveals the
possibilities that may exist in what we have perceived (Andersen, 2000).
Hogarth (2001, pp. 6-7) provides an in-depth definition of intuition based on its
usage in Merriam-Webster's Collegiate Dictionary:
It refers, in one sense, to (a) "immediate apprehension or cognition," (b)
"knowledge or conviction gained by intuition," (c) "ithe power or faculty
of attaining to direct knowledge or cognition without rational thought and
inference" and, in a second sense to (d) "quick and ready insight." Thus
the common understanding is seen to involve elements of speed of
knowing (definitions ar and d) and the lack of a deliberate or rational
thought process (definition c). In addition, there is the notion of a store of
knowledge that has been built up over time through past intuitions
(definition b). Finally, a link is made to the notion of"insight"' (definition
d). Examining the concept of intuition in more depth, it is instructive to
consider it along the dimensions process, content, and correlatres [his
Hogarth (2001) goes on to describe the process of intuition as "characterized by a lack of
awareness of how outcomes--or judgments--have been achieved" (p.7); content as
''intuitive judgments are inferences that can look both backward and forward in time"' (p.
8). They can also represent "outcomes of a stock of knowledge"' (p. 8); correlates as ''the
term iniuitioon suggests certain correlartes [his italics]. Among these are notions of speed
and confidence .. However, neither speed nor certainty are necessarily correlates of
intuitive thought" (p. 10); and insight as "the phenomenon whereby people suddenly
become aware of the solution, or part of the solution, to a problem with which they are
confronted" (p. 12).
Definition of Clinical Intuition
Hogarth's (2001) definition of intuition incorporates the other definitions into a
more thorough explanation that involves elements of quick unconscious knowing,
inferences using hypotheses or beliefs to diagnose/describe/interpret past experience or
predict future experiences, expertise, certainty that our inferences are correct, and
problem solving. Expanding Hogarth (2001) to fit application in counseling, my
definition of clinical intuition is the speedy, unconscious knowing of information about a
client, used to form hypotheses about a client without rational, logical means of what sort
of treatments will work well with a client, and/or used to determine a new course of
action with a client if feeling stuck.
Carl Jung talked about clinical intuition (the ability of a skilled practitioner to
infer a problem without formal diagnosis) and as a means of identifying a personality trait
(Osbeck, 1999). Clinical intuition is similar to counselor judgment, which is "the process
of developing intuition, gathering information. and drawing conclusions about client
concerns" (Haverkamp. 1994, p. 156). Welsh and Lyons (2001, p.299) describe clinical
intuition as "the ability to 'sense' when something is not as it appears to be." Myers
(2002) states clinical intuition is composed of diagnostic intuition (predicting diagnoses)
and therapeutic intuition (predicting the best choice of therapy for the predicted
diagnosis). Each of the above clinical definitions touches on the basics of my definition,
although they do not describe the use of clinical intuition in moments of uncertainty with
clients. These moments of feeling stuck or not knowing how to proceed are ripe
situations for eliciting clinical intuition and therefore, an important component of clinical
intuition I added with my definition.
The Non-Rational Nature of Intuition and Why Studying Intuition is Important
Opponents of intuition have posed different views and different dermnitions. Many
authors describe intuition (all forms and types, including clinical intuition) as the
automatic information-processing that accompanies expertise in a variety of disciplines
(Gambril, 1990; Hall, 2002; Isenberg, 1991; Klein, 2003; Myers, 2002). Intuition is also
described as faulty thinking, incorrect logic, and full of cognitive biases and error by
some contemporary authors (Gambril, 1990, Hall, 2002; Myers, 2002).
Despite these criticisms, intuition and clinical intuition are by their definitions,
outside reason and therefore outside of rational inquiry. However, we cannot ignore
intuition for not fitting nicely into a technical rational "box": it is a valid means of
receiving credible information for many people and must be more deeply understood.
According to Paul Feyerabend (1978), scientific education and the currently
accepted methods of conducting scientific inquiry stifle the growth of knowledge and the
discovery of new ideas. He states that although many believe science needs its strict rules
to promulgate the authority of science, he believes that such strict rules strangulate the
process of discovery. Because the world is a largely unknown entity and we must keep
our options open while studying it, strictly adhering to any particular epistemology hurts
the progress of knowledge. Furthermore, Feyerabend (1978) states that the way we
currently teach science "'cannot be reconciled with a humanitarian attitude" (p. 20)
because it encourages suppressing liberty, individuality, and freedom in the name of
reason and/or scientific methodology.
Feyerabend (1978) stated that the current scientific standard of basing truth and
knowledge on verifiable observations and facts is not the sole method of dictating truth
and knowledge. By fostering such a standard of thought in our scientific education, we
are brainwashing conformists that cannot rely on their creativity or intuitions to find
novel research topics or novel approaches to previously studied phenomena. Creating
conformity in science allows scientists to maintain their '"authority" and to maintain the
status quo of their dominant paradigms by claiming their sole scientific method/approach
leads to absolute truth and knowledge. Feyerabend (1978) states that all methodologies
are flawed, all theories have inconsistent facts, and that there is no absolute truth, only
To break from the terror of reason, we must become anarchists (Feyerabend,
1978). Feyerabend (1978) defines anarchist as:
When choosing the term "'anarchism" for my enterprise I simply followed
general usage. However, anarchism, as it has been practised [sic] in the
past and as it is being practised [sic] today by an ever increasing number
of people has features I am not prepared to support. It cares little for
human lives and human happiness .. and it contains precisely the kind of
Puritanical dedication and seriousness I detest. .. It is for those reasons I
now prefer to use the term Dadatism~ [his italics]. (note, p.21).
Feyerabend believes that the brainwashing in our scientific education for using the
scientific method as the only valid means of knowing is so intrinsic in our Western
culture that even anarchists in other arenas buy into the myth of scientific reason and
knowledge. This devotion to the scientific method is pervasive and difficult to escape in
our culture. Scientific d'adacists should be able to look beyond this attachment to reason
and explore new topics in new ways.
Polanyi (1962) states the scientific community is its own political entity, ensuring
both the authority of its knowledge and its survival through widespread and subtle
manipulation of what is considered "scientific." According to Polanyi, scientific
knowledge is judged on its plausibility (credibility of the topic in light of current
scientific opinion) and its scientific value (an interplay between the accuracy of, the
systematic importance of, and the intrinsic appeal of the topic). The plausibility and
scientific value of topics interact with the originality of research ideas, making some
scientific topics more "valid" than others based on the quality of the interaction. Polanyi
(1962) further elaborates this notion by discussing the nature of facts. To Polanyi, facts
are never absolutely true but only considered as truth by the scientific community
because they fit in with the current scientific opinion.
Polanyi (1962) believes that science must enforce its standards to protect itself
from frauds, as a result, this protection becomes a necessary evil in that some ideas are
not considered scientific or "in vogue" until the historical era or paradigm changes
(Kuhn, 1962/1996). Scientific authority must balance tradition with originality of ideas
while simultaneously suppressing quacks and bad science.
As more and more journals accept and publish qualitative studies and as there are
many researchers in traditionally "rational'' fields (medicine, nursing, and business)
studying intuition, it appears that the paradigm is shifting to make room for more
qualitative research on intuition. As a result, it appears that the balance amongst
plausibility, scientific value and the creativity (Polanyi, 1962) of intuition might now be
"right" for studying intuition.
Because intuition is, by its very nature, non-rational, it does not mean it is less
important or less valuable to human decision-making or experiences. Faithfully adhering
to any one way of creating knowledge, such as the awesome devotion our modern
Western society gives to the scientific method, can ultimately limit what we know about
humans and the world in which we live to topics that may be easily studied by the
Rationale for the Current Study
The rationale for this study is to better define and understand how counselors
make meaning of and use their clinical intuitions with clients by using grounded theory
(Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967;
Strauss, 1987: Strauss & Corbin, 1998). Despite the many divergent views of intuition
and clinical intuition, there are relatively few empirical studies discussing clinical
intuition specifically in counseling. I hope to better understand how counselors construct
knowledge about their clients using clinical intuition.
I developed a theory/perspective (from a constructivist framework) that furthers
understanding of counselors' meaning and use of clinical intuition, based in data from my
participants. Since there is little empirical research on clinical intuition in general and
even less specifically to its use in counseling, grounded theory is a conceptually helpful
way to approach the topic. Additionally, as intuition is non-rational, using grounded
theory's more structured set of analytic tools will help to ground the analysis.
From an early age, I have had numerous experiences with various types of
knowing information without rational explanation. Mainly, these experiences were with
picking up the moods and feelings of friends, family, and strangers and the occasional
precognitive dream. I can consciously read people's emotions well but my intuitive
reading of emotions occurs differently, typically when a person hides her/his true
mood/feelings from me. For instance, a person smiles and acts in other verbal/nonverbal
ways that should communicate happiness. I frequently can sense when his/her true
feelings are quite well masked and are quite different than the emotional face the person
is wearing and stories the person is telling. However, I am aware that just because I can
sense the true mood/feelings does not mean someone is ready to discuss them. I also
intuitively sense the appropriate time for me to confront his/her affective dissonance and
not hurt or offend the person/client.
Throughout my life, I have seen the true feelings/moods of my friends, family,
strangers, associates, and more recently clients in counseling environments. I found
myself frustrated quite often that other people did not read me the way I could read their
emotions and moods; I thought everyone did it. The more people in my life I spoke with,
the more I realized my reading of people was not a trait shared by everyone. I began to
grow curious as to how this intuitive ability developed in me (and others like me) but not
Additionally, my ability to intuitively pick up emotional cues has also helped me
avoid harm throughout my life; somehow, I can gauge if a situation or person is unstable,
dangerous, unhealthy, or harmful. I have never been able to explain it rationally nor have
I been able to verify the truth of my experience, because I act upon my intuition and will
go in the opposite direction from the possible harm; thus, no harm results and I cannot
know for certain if I was correct in my feelings.
I have had intuitive dreams most of my life. They usually fall more on the side of
precognition than on the academic view of intuition. Unfortunately, most of my
experiences with precognition involve dreaming about someone dying (usually someone I
am acquainted with or close to but occasionally a celebrity or stranger) and then, within a
few days, discovering that indeed the person died (except for strangers, I rarely confirm
their deaths because I never felt the need).
In addition to my death dreams, I often dream of friends in moments of crisis. I
may have not spoken to him/her for several months and I will dream of her/him in
emotional or physical pain. When I wake up, I feel compelled to check on the person
from my dream, and more often than chance, the person is going through a period of
upheaval, transition, anxiety, or depression. My precognitive and intuitive dreams always
have a different sense to them then my unconscious-working-out-my-daily-residue-ad
issues dreams; the precognitive or intuitive dreams are clearer and have a less "dream-
like"' quality to them. My friends and family think I am very bizarre for my dreams, so I
never assumed that everyone had them (although I believe everyone can). Wondering
how my dreams related to my waking intuition relates strongly to my curiosity about the
nature of intuition.
Once I began seeing clients during my master's and doctoral programs, I realized
that my intuitive skills greatly helped me during the counseling process. The experiences
of my clinical intuition are too numerous to describe; however, most of my clinical
intuitive experiences occurred spontaneously in session, when I could sense something
just not "fitting in"' with the clients' words. When I have been stuck with clients, my
intuition has helped me find new approaches and paths to follow with clients.
I never scientifically tested my experiences but I also never doubted their
accuracy and reality. When I began my doctoral training, I found my growing researcher
skills and knowledge conflicting with my intuitive processes. I felt caught between my
personal experiences and beliefs and knowing that these experiences and beliefs were not
"'scientific" or "rational." This cognitive dissonance between rational science and my
non-rational experiences sparked a growing curiosity in finding ways to work within the
technical rational system in order to bring some rational validity and understanding to my
non-rational experiences. Although there is wide acceptance in the non-academic world
and growing acceptance in the scholarly world of intuition research, it is often considered
too nebulous or mysterious a topic to study. The debate rages on between popular culture
and hard science. From my perspective, believing in intuition and believing in scientific
research are not mutually exclusive.
Because I have such vivid experiences with intuition in my personal life and
clinical intuition in my professional life, I do believe that using intuition is an important
and vital part of effective counseling. As grounded theory methods depend on the
worldview of the analyst, I will try to bracket my subjectivity as much as possible during
the data collection and analysis of my study.
Significance of Study
Intuition has been widely ignored by the scientific community because it was
considered implausible and without scientific value. Most writings on intuition involved
denigrating and outlining precisely why it was not valid in logical, rational thought and
some authors continue to do so despite intuition's growing acceptance in certain H'elds.
Recently, disciplines such as business science, nursing, and other medical fields have
changed their scientific opinions of intuition and clinical intuition; as a result, many more
theories and studies on intuition are appearing in each discipline's literature. It is my
belief that the field of counselor education is becoming ready to accept inquiry into the
use of intuition/clinical intuition in counseling.
REVIEW OF THE LITERATURE
The "Scientific" Study of Intuition
Despite the scientific community's relative disregard for studies of intuition,
many inquiries have been performed on the concept during the past 100 years (Osbeck,
1999). Shirley and Lagan-Fox ( 1996) provide an excellent review of the early theories
and early empirical studies conducted on intuition. Many of these initial studies were
limited to the recording of anecdotes or were aimed at proving the existence of intuition
(Petitmengin-Peugeot, 1999). Recent writing and research into intuition describes it in
one of two ways: (1 ) the connection of intuition to the transpersonal, spiritual, and natural
healing; or (2) the information-processing/decision-making aspects of intuition and its
relationship to how various disciplines make professional decisions.
Most of the transpersonal literature agrees that intuition is a valid method of
receiving information and there is little debate that intuition exists. The transpersonal
perspective is that intuition is a gift that connects us to the universe. Much of the
transpersonal literature examines the nature of intuition and how we can use intuition to
make our lives (mind-body-spirit) and the lives of those around us more complete.
There is much debate in the literature regarding intuition and professional
decision-making. Some authors hail it as the way to go beyond what has become the
traditional, positivist approach of describing "truth'' (Redding, 2001; Schiin, 1983; Welsh
& Lyons, 2001). Some authors view intuition as one preference for processing
information (Myers, 1998; Jung, 1921/1971). Other authors view intuition as a natural
component of advanced critical thinking skills and/or expertise (De Bono, 1991;
Isenberg, 1991; Klein, 2003; Redding, 2001; Schain, 1983). Even other authors describe
intuition as riddled with bias and therefore has little part in professional decision-making
(Gambril, 1990; Hall, 2001; Myers, 2002).
Transpersonal Views of Intuition
Attempts to discuss intuition in the transpersonal and/or parapsychological
literature are usually aimed at trying to prove the existence of intuitive phenomena and
ignore the intuitive experience itself (Petitmengin-Peugeot. 1999). However, there is
some mention of the experience of intuition in the literature. Bohart (1999) describes the
intuitive experience based on qualitative descriptions of it from artists as nonconceptual,
realizations coming out of the blue, and a sense of imminence directly preceding the
insight. No formal preparation was necessary; the creative insights merely "dawned" on
The Intuitive Experience
Goldberg (1983) describes the intuitive experience in terms of incubation (time
away from the activity) and insight (when the intuition occurs). The intuition will be
holistic and received in a variety of different means through one of our senses, emotions,
or it can be a "'flash in the mind" (Goldberg, 1983, p. 72).
Based on interviews with people who have experienced intuition, Petitmengin-
Peugeot has formulated a generic model of the intuitive experience (1999). Gaining
insight from an unknown source is described as a process of four stages: letting go,
connecting to a higher source, listening to this higher source, and receiving the intuition.
The phase of letting go is a phase of quieting the rational mind, making it possible to shift
attention from normal, everyday consciousness to a higher, receptive level of awareness.
This can be done through shifting the center of attention from the head to the body by
changing posture, a gathering and realignment, transforming the breathing into a slow
pace and then shifting consciousness to the back of the skull (Petitmengin-Peugeot,
1999). While performing the body modification, mental activity must also be altered to
allow for visualization and/or prayer. A sense of abandoning normal reality occurs, with a
sense of feeling connected to the universe and a sense of opening up (1 999).
The connection phase occurs once the intuitive state has been reached. This
appears to be a deepening of the senses of connecting and opening up to receive
information. Based on the individual, this can be achieved unconsciously through
focusing on an object and altering your senses. However, some people described a
conscious process by introjecting (welcoming the other into one's self), extending
(opening the self further to accept the other) or resonating with the higher source
After letting go, the person is in calm state, ready to receive insight from the
universe. This can be done through a special kind of attention: one that is "internal,
peripheral, and involuntary" (Petitmengin-Peugeot. 1999. p. 67). In addition to this
attention, the person will usually favor a particular 'listening' style among the visual
(clairvoyance), auditory (clairaudience) or kinesthetic (clairsentience) methods.
The stage of receiving the intuition is usually immediately preceded by a moment
of confusion leading to the clarity of the insight. Based on the preferred sense of
receiving the intuition, it will appear, bringing a feeling of certitude and coherence
(Petitmengin-Peugeot. 1999). To bring the insight into conscious awareness, the receiver
must consciously grasp, chase or welcome the intuition.
Spirituality, Psychic Intuition, and Health
Several studies presume intuition to exist and examine differences between the
modalities. In a study by Steinkamp (1998), the literature involving precognition and
clairvoyance testing from 1935-1997 was examined and a meta-analysis was performed
to determine which form of intuition is more effective at predicting the future
(Steinkamp, 1998). She found that there were no statistically significant differences to
support that clairvoyance works better than precognition. (Steinkamp. 1998).
In a later study by the same author, precognition was tested against clairvoyant
perceptions leading to a premonition. For example, did someone who predicted an
airplane disaster actually have a true premonition or did he just psychically pick up on a
faulty engine (Steinkamp, 2000)? The results seem to suggest that true precognition may
not be possible but that psychic feelings, sounds and visions are a reality (Steinkamp,
Other contemporary views of intuition hypothesize the connection of intuition to
the mind-body-spirit. in terms of an early warning system of disease. Many of the early
psychological theorists and contemporary researchers believe there is a connection
between the body and the mind (Barasch, 1993; Fernald, 2000; Freud, 1900/1965; Jung,
1954/1957/1960/1 977: Myers, Sweeney, & Witmer, 2000, Reich, 1972/1933). Although
several early theorists such as Carl Jung and William James acknowledged the role of
spirituality in health, serious research in this area has only recently begun (James, 1902;
Maltby & Day, 2001; Myers et al., 2000; Thoresen, 1999; Woods & Ironson, 1999). Total
health is comprised of and influenced by the interaction of all three elements (Barasch,
1993), i.e., it is logical that warnings of illness could arise in any of the dimensions; be it
a psychosomatic illness because of past trauma, the influence of attitude on heart disease,
or the mind-body-spirit warning of potential mental or physical illness through intuition
Intuitive Information-Processing and Decision-Making
The Functions of Intuition
Vaughan (1979) postulated that there are four levels of awareness for intuitive
experiences: physical, emotional, mental, and spiritual. Each level of awareness describes
the modality through which intuitive information is received.
Physical intuitions are those that "frequently depend on physical and emotional
cues that bring them to conscious awareness." (Vaughan, 1979, p. 66). These kinds of
intuitions are usually experienced at a physical level, such as a physical symptom or a pit
in the stomach. Emotional intuition "comes into consciousness through feelings"
(Vaughan, 1979, p. 68) such as an immediate like or dislike to a person without knowing
why or a feeling of connection with another person's feelings or thoughts. Vaughan
describes mental intuition as "'awareness through images, or what is called 'inner vision'"
(p. 73). Examples of this kind of intuition include unconscious pattern recognition that
allows a person to solve a problem or the ''Aha!" moment people may experience after
trying to solve a problem through rational thought with no avail. Finally, spiritual
intuition to Vaughan (1979) is "associated with mystical experience, and at this level,
intuition is "pure."' Pure, spiritual intuition is distinguished from other forms by its
independence from sensations, feelings, and thoughts"' (p. 77). Examples of spiritual
intuition are peak experiences, where one feels connected to the universe and appears to
comprehend the nature of reality.
Goldberg (1983) classifies intuition in into different functions: discovery,
creativity, evaluation, operation, prediction, and illumination. All of the functions
describe ways in which intuitive information serves the person receiving the intuitions.
Discovery intuition (Goldberg, 1983) is similar to Vaughan's (1979) description
of mental intuition, where one discovers a solution to an elusive problem. Creative
intuition often works with discovery but allows for novel approaches to art, science,
and/or life (Goldberg, 1983). Evaluative intuition does not examine or investigate choices
rationally as the name might suggest; examination and investigation are rational methods
(Goldberg, 1983). Instead, it gives a "'binary kind of function that tells us go or don't go,
or yes or no." (Goldberg, 1983. p. 51) such as when you knowt not to take a particular job
offer but can think of no logical reason to decline so you take it and the job ends badly.
Operational intuition is the "most subtle, almost spooky form .. [that] guides us
this way and that, sometimes with declarative force, sometimes with gentle grace. It
prompts us without telling us why, and sometimes without our knowing at all"
(Goldberg. 1983, p.54). Operational intuition is similar to evaluative intuition; however,
with evaluative intuition, there is a known decision to make or problem to solve. With
operational intuition, the "'answer" comes before the problem or decision.
Predictive intuition involves some intuitive decision and/or acting about the
future, either explicit or implicit, which is precise and not likely to be made by everyone
acting on the same limited information. For instance, if I regularly read the stock listings
and have seen a gradual increase in a particular stock that I then decide to buy and make a
lot of money on, that is not predictive intuition. However, it would be predictive intuition
if I knew absolutely nothing about stocks and had not heard about this stock before and
then decide to buy it and make a lot of money.
Finally, intuition as illumination is similar to Vaughan's (1979) concept of
spiritual intuition, in that it refers to those intuitions related to self~-realization,
communication with a higher power/the universe, and involves some element of
transcendence (Goldberg. 1983). An example of illuminative intuition would be if during
meditation, I felt a powerful, strong connection to the universe and understood the nature
of death for a fleeting moment that stayed with me after my meditation ended.
Jung's Theory of Psychological Type
Carl Jung (1921/1971 ) describes intuition as one of his four fundamental
psychological functions of the personality. According to Jung. intuition is a means of
perception through unconscious processes and is experienced through sensing the deep
significance and mystical connections of an everyday object or event (Hall. Lindzey, &
According to Andersen (2000), Jung's typology rests on two elements: attitudes
(way of reacting in life) & functions (how we orient ourselves in the world; a way of
solving problems) p. 47-48). These attitudes and functions are in our conscious
awareness. An important element of Jung's theory is that all the different attitudes and
functions are equally good; i.e., there is not one combination of attitudes and functions
that is the **best." People have a dominant attitude and function that they prefer. These
preferences comprise a person's psychological type.
There are two different ways of reacting in life: extraversion & introversion.
These attitudes differ in their directions of focus and their sources of energy (Andersen,
2000). Extraverts tend to act quickly, are more inclined towards action, and dislike
loneliness (Jung, 1921/1971). Introverts tend to react more slowly, integrate outside info
and are energized by alone time, unlike their extraverted counterparts (Jung, 1921/1971).
Functions describe the strategies people employ to acquire and process
information." (Hall, Lindzey, & Cam~pbell, 1998, p. 91). There are two different groups
of functions according to Jung's theory (1921/1971). The first category of function is
perception. The perception functions tell us how we perceive the world, the problem or
task and/or ways of taking in information (Andersen, 2000). Within this category, there
are two levels, sensing and intuition. Sensing is the function that tells us something exists
and is perception based on our senses. Sensing types perceive things as they are, have a
respect for facts & information, and are detail-oriented. In contrast, the function of
intuition reveals the possibilities which may exist in what we have perceived, that tells us
about the possibilities in the future, and enlightens us on the atmosphere surrounding all
experiences (Andersen, 2000). Intuitive types concentrate on possibilities and are less
concerned with the details. They often find solutions directly without basing them on
The next function category is j judgment. The judgment functions tell us how we
judge a problem or situation once it is perceived and includes our ways of making
decisions (Andersen, 2000). There are two levels within the judgment function: thinking
and feeling. Thinking is the function that tells us what something is, based on our existing
knowledge. Thinking types tend to be analytical, particular, precise, & logical. They see
things from an intellectual angle and often miss the emotional sides of a situation/
problem (Andersen, 2000). Feeling is the function that tells us how to relate to our
perceptions based on our subjective value system. Feeling types are interested in other
people's feelings and dislike analysis. They stick to their own values, their own likes, and
dislikes. They enjoy and prefer to work together with other people. (Andersen, 2000).
Developed by Isabel Myers and Katharine Briggs in 1940s, the Myers-Briggs
Type Indicator (MBTI) is one of the most widely studied and used assessment
instruments in the world (Sharf, 2002). The MBTI assesses psychological type based on
combinations of the attitudes and functions according to Jung's Theory of Psychological
Type and as modified by Katharine Briggs. There are sixteen combinations of types:
IST), ISFJ, INFJ, INTJ, ISTP, ISFP, INFP, INTP, ESTP, ESFP, ENFP, ENTP, ESTJ,
ESFJ, ENFJ, ENTJ. The last letter represents a third factor, not described by Jung's
theory. In addition to the two functions of perceiving and judging, a third factor was
added that describes which of the two functions a person finds more important.
According to Sharf (2002), judging types are organized, planned, decisive, set goals, and
are systematic. In contrast, perceiving types are flexible, spontaneous, tentative, let life
happen, undaunted by surprise, and open to change.
Andersen (2000) studied if intuitive managers (based on Jungian Type Theory)
were more effective managers than those using other decision-making processes.
Andersen examined 209 managers' decision-making styles according to Jungian Type
Theory, measured by the MBTI and the Keegan Type Indicator Form B. No statistically
significant differences found between decision-making style and managerial
effectiveness. However, 32% of effective managers used intuition as their primary mode
of perception. Although the study found no statistically significant differences between
intuitive managers and other managers, Andersen states that this investigation was merely
an exploratory & descriptive study to determine if the subject was worthy of further
study. Based on the high number of intuitive and effective managers, Andersen states that
more research is needed to further explore this connection.
Intuition and Creativity
Another contemporary view of intuition is that it is the foundation of creativity.
According to Bohart (1999), there is support in the literature for the idea that creativity
arises from "felt, tacit, intuitive and perceptual knowing" (p. 297). Creativity is not
limited to artistic expression. Generating novel ideas and problem solving, particularly in
moments of uncertainty can also be viewed as creativity.
Sternberg and Lubart (1991, as cited in Myers, 2002) describe five components to
creativity: (a) expertise; (b) imaginative thinking skills; (c) a venturesome personality; (d)
intrinsic motivation; and (e) a creative environment. Creative people can approach and
solve new situations and problems because they may have faced and solved similar
situations in the past (expertise); they can recognize patterns and see things in different
ways (imaginative thinking skills); they persevere, tolerate ambiguity/risk well, and seek
new experiences (venturesome personality); they are interested in solving problems for
self-satisfaction and not because of an outside influence (intrinsic motivation); and are in
environments were their ideas are sparked and developed in relationship to others
(creative environment). Intuition is the means creative people use to gain insight and
solve novel problems.
Intuition as a Component of Critical Thinking Skills
Myers (2002) examined the evidence for the powers and perils of intuition in
relationship to decision-making. Myers describes the validity of intuition as a perceptive,
automatic, cognitive process affected by memory, attention, expertise, evolution, social
experiences, creativity, and mental shortcuts. Intuition results from all of these things
interacting with one another and contributes to our effective decision-making. The most
intriguing part of Myers' book is his descriptions of divided attention and priming; and
the dual attitude system.
Myers (2002) postulates that intuition is simply our unconscious recognition and
perception of unattended stimuli incorporated into automatic, experiential knowing as a
result of implicit memory (learning something without remembering where we learned
it). Myers states that there are two ways of knowing: "automatic (unconscious) and
controlled (conscious)" (2002, p. 29). Additionally, Myers expounds these different ways
of knowing information as either experiential knowing or rational knowing (Epstein,
1994, as cited in Myers, 2002). Experiential knowing is "rapid, emotional, mediated by
vibes from past experience, self-evident, and generalized"' (Myers, 2002, p. 30). Rational
knowing, on the other hand, is "slow, logical, mediated by conscious appraisal, justified
with logic and evidence, and differentiated" (Myers, 2002, p. 30). According to Myers
(2002), intuition is therefore a part of our unconscious, experiential knowing system,
sometimes valid, but most of the time invalidated by its generalizability and therefore,
Much of the disagreement between scientists concerning the substance and
significance of intuition results from the non-rational basis of intuition. Science is, by its
nature, knowledge received through rational processes, aimed at refuting hypotheses and
beliefs in analytical, logical procedures. As described in Chapter 1, intuition is, by its
nature, knowledge received through often sudden, non-rational, non-analytical processes,
aimed at expanding understanding past or predicting future outcomes. Science and
intuition appear to be mutually exclusive.
However, several scholars have responded to the criticism of intuition in direct
and indirect ways (De Bono, 1991; Feyerabend, 1978; Polanyi, 1966/1983; Schain, 1983).
Similarly to Feyerabend (1978) and Polanyi (1962), Schain (1983) argues that Western
culture since the Age of Reason has nullified any other means of receiving and verifying
information outside the realm of "technical rationality"' (science). As a result, our
universities and critical thinkers of the day train future scholars to be future skeptics, only
trusting the technical rational method of discovering truth and knowledge. That is, we are
trained to believe that anything outside that proscribed scientific realm and methodology
is illogical and manipulative of non-critical thinkers.
Schiin (1983) described a different method of receiving and verifying information
termed "reflection-in-action" that is not necessarily more valid than the scientific method,
but occurs more often in practice. Practitioners often do not discover new knowledge
scientifically, they discover it through reflecting on the information in the moment,
testing their assumptions/hypotheses in the moment, and refuting/accepting these
hypotheses in the moment. Information received through reflection-in-action is a function
of expertise, a form of acquired tacit knowledge tapping into that automatic knowledge
store practitioners develop through their experiences. Schdn (1983) argues that relying
solely on a scientific research experiment, removed from the experiences of those in
practice, greatly limits our understanding of the world around us.
Sch~n's (1983) reflection-in-action through acquired tacit knowledge is similar to
Michael Polanyi's (1966/1 983) views when he states that as human beings, .. w~e can
know more than wie can tell [his italics] (p. 4), which he terms tacit knowledge. There
are two basic structures/kinds of knowing of tacit knowing: specifiably known
knowledge (i.e., something we know because we have attended to it) and functional
relational aspect of knowledge (i.e., something tacit that we only know because our
awareness of attending to the object). He also names these as the distal term (stimulus we
attend to, specifiably known) and the proximal term (tacit knowledge arising from our
attending to the fact that we attended to the stimulus). Polanyi (1966/1983) further states
that our full tacit knowledge of an event/interaction/stimulus is only made available to us
by ascribing meaning to the two terms and their interaction. Using Gestalt psychology
language to describe the proximal and distal terms, the proximal term represents the parts
and the distal term represents the Gestalt (or whole). We are aware of the whole by
making meaning out of the parts but we are not truly aware of the parts. This
unawareness of the 'parts' is the basis for tacit knowledge: that we know the whole
without knowing how we know the parts.
Polanyi (1966/1983) further discusses the nature of tacit knowledge by examining
the process of awareness. Polanyi states that we can .. make a thing function as the
proximal term of tacit knowing, we incorporate it in out body--or extend our body to
include it--so that we come to dwell in it." (p. I6). This indwelling of the proximal term
is similar to but more detailed than the concept of empathy. We can tacitly experience
knowledge of another by making their lives/experiences/ "parts" indwell in our minds.
Polanyi (1966/1983) believes that tacit knowledge allows us to bypass the process of
knowing through paying extremely close attention to everything around us thus avoiding
the problem of losing sight or meaning of something by paying to close attention to it.
Additionally, Polanyi states that if we try to elucidate and become aware of the tacit
process by which we know life, we will never fully be able to explain the process in a
way that makes the knowledge any more valid than it was tacitly. The act of trying to
make tacit knowledge conscious may cause us to lose sight of its meaning by paying to
Polanyi's (1966/1983) ideas regarding tacit knowledge are similar to the concept
of intuition. Intuition is often defined as knowing something without knowing how we
know and not being able to tell how we know the intuition. From Polanyi's (1966/1983)
concept of tacit knowledge, we can further develop the concept of intuition to be an
unconscious awareness of an object's parts to more fully understand the object itself.
Intuition as tacit knowledge supports the view that intuition is a well-developed system of
pattern recognition postulated by authors such as Benner & Tanner (1984) and Schiin
De Bono (1991) argues that there are two human thinking systems in decision-
making: vertical thinking and lateral thinking, each separate poles on a thinking
continuum. Vertical thinking is what we consider typical of a scientific approach to the
world; "it is selective. It seeks to judge. It seeks to prove and establish points and
relationships. .. It is concerned with stability with finding an answer so satisfactory
that one can rest with it" (De Bono, 1991, p. 19). De Bono (1991) further describes
vertical thinking as (a) judgment based on the "YES/NO system, and selection is by
exclusion of all those ideas to which the NO label can be attached" (p. 19); (b) "analytical
. .. interested in where an ideas comes from: this is the backward use of information .
used to describe [his italics] what has happened in one's own thinking" (p. 20); (c) "seeks
to establish continuity .. one step follows directly from the preceding step in a logical
sequence .. the conclusion must come after the evidence" (p. 20); (d) "chooses what is
to be considered. Anything else is rejected. This choice of what is relevant depends
entirely on the original way of looking at the situation" (p. 21); (e) "'proceeds along well-
established patterns because it is seeking proof and proof is most easily found by using
such patterns"' (p. 21); and (f) "promises at least a minimal result" (p. 21).
According to De Bono (1991), lateral thinking is the opposite of vertical thinking.
Lateral thinking is concerned with generating new possibilities, novel ideas, movement,
and change. Unlike vertical thinking, which is concerned with the stability of a
satisfactory answer, lateral thinking requires no adequate solution but strives to find a
better one. Lateral thinking is never an attempt to prove something and always an attempt
to generate new ideas. There is no judgment of right or wrong or YES/NO with lateral
thinking: in fact, De Bono (1991) states the "only 'wrong' is the arrogance or rigidity
with which an idea is held" (p. 20). Lateral thinking uses ideas to generate new ideas if
the current idea turns out to be inadequate.
In lateral thinking, the conclusion may come before the evidence. However, De
Bono (1991) states further:
This is not to say that one adopts a conclusion and then seeks to justify it
by rationalization. Such a procedure would imply an arrogant certainty in
the conclusion that is the opposite of lateral thinking. The process is rather
one of making a provocative jump to a new position and, once there, one
is suddenly able to see things in a new way. The new way must of course
prove itself by being effective (pp. 20-21).
Additionally, lateral thinking welcomes an amount of chance in generating new ideas,
because chance is one way of creating discontinuity in a situation (De Bono, 1991).
Finally, lateral thinking does not promise an answer to the solution, but if skilled in
lateral thinking, there is a high probability that a solution will emerge (De Bono, 1991).
De Bono ( 1991 ) does not imply that the two processes of thought are separate,
one can use both vertical and lateral thinking or a mixture of the two on a continuum.
Based on its above descriptions, lateral thinking seems very similar to intuition and is
useful in situations where a new approach or solution is needed for an uncertain problem
and vertical thinking is useful in determining if the new approach or solution is effective.
Unfortunately f~or most problem-solvers, De Bono (1991) states that most people "might
use lateral thinking some 5 percent of the time and vertical thinking 95 percent of the
time. .. It depends a good deal on the nature of the situation" (p. 22). The good news is
that lateral thinking skills can be developed and tuned, just as vertical thinking skills are
during our traditional education.
Although De Bono (1991) never specifically mentions intuition as being a part of
lateral thinking, intuition closely follows the description of lateral thinking. The process
of lateral thinking can also explain how intuition is separate from bias, in lateral thinking,
one comes up with the solution before the evidence (intuition) but is not seeking to
confirm the solution with evidence in the past, as that would negate the process of lateral
thinking. Lateral thinking is concerned with "the generating of new ideas and new
approaches, and with the escape from old ones. It is not a method for decision or for
action. Once the ideas have been generated, one has to satisfy oneself as to their
usefidness [his italics] before putting them into action" (p. 23). This appears to be very
similar to what occurs during clinical intuition, the generation of ideas outside of logical
thought when faced with uncertainty or feeling stuck with a client that are then checked
with the client without judgment as to "right or wrong."
According to Osbeck (1999), one may infer from the studies and way intuition is
described in such studies that there are three characteristics of intuition as a basis for
judgment. The first description is that intuition is unconscious processing (Osbeck, 1999).
The information received through intuition is implicit and from an unknown source.
Secondly, since this information influencing a decision is unconscious, intuition is
viewed as an inferential process, similar to the reasoning from a conscious process, but
operating at a level below awareness (Osbeck, 1999). Thirdly, information received
through intuition is frequently considered irrational. These characteristics lead to the way
intuition is viewed by psychological science: that there are two models of information
processing occurring, the cognitive system with its logic and reasoning and the intuitive
system with its automatic, creative and narrative style (Osbeck. 1999).
Intuition as Cognitive Bias in Decision-Making
Early cognitive psychologists examined intuition "as a basis for judgment in
problem solving" (Osbeck, 1999, p. 231). Osbeck (1999) describes the current interest in
intuition and its basis for judgment by comparing intuitive judgments to those formed by
more scientific methods. According to Osbeck, the results have so far been inconclusive.
Intuitive problem solving seems to be riddled with the same errors and biases in
judgments that formal hypotheses are (Osbeck, 1999). According to Osbeck, the studies
that have been done on intuition lead to two general conclusions: decisions from intuition
are less accurate than traditional reasoning and the accuracy improves with experience. In
addition to studying intuitive judgments, contemporary research has focused on decision-
making (intuition vs. analysis) and the impact of intuition on various fields (Osbeck,
Osbeck (1999) describes the studies on intuition as less accurate than logic. I
believe these studies are also biased against the use of intuition and thus reflect that bias
in their results. There is a general lack of many outcome studies on intuition. Further
outcome studies contradict Osbeck's conclusion by supporting the notion of intuition and
generally conclude that more qualitative and quantitative studies are needed.
As part of our information-processing systems. humans have developed strategies
to quickly process information and then quickly know how to act. These strategies (called
heuristics) have kept us alive and evolving, but are often associated with error in non-
fight-or-flight situations (Myers, 2002). When applying these heuristics in making
decisions, the strategies have associated biases, which can lead to incorrect conclusions
and assumptions. As intuition is described by many authors as part of information-
processing and decision-making, then it is also subject to the same errors as rational,
logical analysis. Many authors have commented on the links between intuition and
cognitive error/bias (Eisengart & Faiver, 1996; Gambril. 1990; Hall, 2002; Myers, 2002;
Osbeck, 1999; Tversky & Kahneman, 1974). Some of these errors in thinking include (a)
memory construction; (b) misreading our own minds: (c) mispredicting our own feelings
and behavior; (d) self-serving bias; (e) overconfidence bias; (f) hindsight bias; (g)
fundamental attribution error; (h) belief perseverance and confirmation bias; (i)
representativeness heuristic; (j) availability heuristic; (k) adjustment and anchoring; (1)
framing effect bias; (m) illusory correlation; (n) avoiding harm from acts of commission
than from acts of omission; (o) overlooking the normalcy of events; (p) socio-cultural
Each of these biases involves making incorrect assumptions based on faulty logic.
Belief perseverance and the confirmation bias are most closely involved with intuitive
decisions. Belief perseverance is the phenomenon that if we think our beliefs are correct,
then they tend to have a certain longevity despite evidence to the contrary (Gambril,
1990; Myers, 2002). The confirmation bias occurs when we form a belief. Humans tend
to search for evidence to confirm their beliefs, making cases for something that may be
incorrect. "On target" intuitions may actually be erroneous beliefs persevering despite
opposing evidence, as we hunt for evidence that confirms our intuitions.
In Gambril's (1990) C.ritical Thinking in Clinical Practice, she discusses in detail
the errors that may arise in cognition during work with a patient/client, trying to help
practitioners become more accurate and precise thinkers and thus, clinicians. Intuition
judgments were condemned as inaccurate judgments, erroneously believed to be correct
and with longevity that causes the clinician to seek evidence supporting the 'intuition'
(confirmation bias). However, throughout a book aimed at eliminating bias from clinical
decision-making. much of it is biased toward promoting logic and analysis as the only
valid critical thinking skills. By negating the use of intuition in clinical decision-making.
Gambril ignores what may be an entirely different information-processing system
operating, and may prove to be more accurate than logical/ analytical information-
The literature linking intuition to cognitive bias does not intuitively nor logically
feel correct. The literature largely agrees that intuitive knowledge is from an unknown
source and therefore, not received through logical, analytical means (lateral thinking). If
this is the case, then biases and errors occurring in logical, analytical means (vertical
thinking) do not truly apply to the lateral, intuitive process. However, none of the authors
addressed the logical leap they made associating the cognitive errors/bias in logical and
analytical thinking with intuitive thinking. If the thinking systems are different, then the
biases and errors applying to one do not necessarily apply to another. Many positivist
authors dismiss intuition's use in decision-making by condemning it as illogical and full
of cognitive errors that arise from a different thinking process entirely. As vertical
(analytic) thinking is prone to such errors in judgment (and agreed upon in the literature),
why are the opponents of intuition not condemning analysis as so full of cognitive errors
that we should not use it?
Outcome Studies on Intuition and Business Decision-Making
Most of the literature on intuition in the business world describes the connection
between intuitive thinking and senior management/executives and entrepreneurs.
According to Shirley & Lagan-Fox (1996), intuition is becoming a highly valued skill in
the business world. Because intuitive processing and decision-making are highly valued
skills, there is an increasing amount of research in this area over the last fifteen years.
In what has become a landmark study in the field of intuition, Agor (1989)
studied over 200 executives' decisions. Agor (1989) found that "'good intuitive decisions
were, in part, based on input from facts and experience gained over the years, combined
and integrated with a well-honed sensitivity or openness to other, more unconscious
processes" (pp. 158-159). Furthermore, Agor's study "suggested that intuition is most
useful to managers in uncertain situations where they are faced with insufficient facts and
complex alternatives." (Clarke & Mackaness, 2001. p. 147).
Allinson, Chell, Hayes (2000) investigated if successful entrepreneurs are more
intuitive than managers, based on the unknown nature of starting a business. Using the
Cognitive Style Index (a questionnaire measuring intuition versus analysis), the authors
compared 156 replies from entrepreneurs with those of 546 managers from various
organizations. They found that successful entrepreneurs are more intuitive than general
population of junior & middle managers, but are similar in cognitive style to senior
managers. The authors adequately describe the limitations of their study as merely an
exploratory study and using a convenience sample. Despite these limitations, the study
was conducted with many attempts to control biases in the research process and was a
good empirical study. The authors state the need for further research in the area,
particularly since their hypotheses were supported by their data.
Clarke & Mackaness (2001 ) conducted a qualitative study of cognitive mapping
and the intuitive elements in cognitive decision making theory of executives. According
to the authors, cognitive mapping:
is a technique that has been used widely by management researchers in a
variety of different contexts to explore individual perceptual schema .
can be seen as a model of 'action-oriented thinking' about a situation in
which arrows signify influences in a line of argument linking cause and
effect. Such mapping makes comprehension transparent. The mapping
process involves respondents identifying factors affecting a particular
decision-making 'goal'. In case of strategic decisions, this can be some
measure of the effectiveness or quality of the decision itself (p. 1 52).
Despite all of the theoretical information given in the article, only four interviews were
done. Three of the interviews were conducted from managers within a single
organization, interviewing a fourth manager from outside the organization for a control
group. The authors found that senior managers were more intuitive (used more non-
factual information) than functional (lower-level) managers. The authors posited that
perhaps the differences were related to experience and not intuition, as their study
suggests. Although the authors analyzed the interviews and found general themes,
generalizability of their results must be viewed with caution due to the very small sample
size. Finally, the authors describe the study as an exploratory study with a small sample
and that more research is needed in this area.
Intuition, Expertise and Clinical Decision-Making
Clinical Intuition in Nursing
Numerous articles have been written on the importance of including intuition as a
valid part of clinical decision making in nursing. Many of the articles describe nurses'
experiences with intuition in their treatment and care of patients, the prevalence of
nurses' intuitive experiences with patients, and how it is a powerful diagnostic tool
(Benner, 1984/2001; Benner & Tanner, 1987; Brooks & Thomas, 1997; Buckingham &
Adams, 2000; Buckingham & Adams, 2000; Miller, 1993; Miller, 1995: Miller & Rew,
1989; Perry, 2000; Redding, 2001; Rew, 1986; Rew, 1987; Rew, 1988; Rew & Barrow,
1989; Ruth-Sahd, 1993: Thompson & Dowding, 2001; Welsh & Lyons, 2001). Because
of the growing acceptance of intuition in the nursing field, there are also an increasing
number of research studies to explore its connections to clinical skills.
Redding (2001) states that advanced critical thinking skills are needed in those
making clinical decisions. Critical thinking is "purposeful, self-regulatory judgment that
results in interpretation, analysis, evaluation, and inference, as well as explanation of the
evidential, conceptual, methodological, criteriological, or contextual considerations upon
which such judgment is based" (Redding, 1991, p. 57). From a nursing perspective,
Redding (1991) describes the critical thinking components involved in making clinical
judgments as a function of attitudes and dispositions; domain-specific knowledge;
cognitive skills and com~petencies; experience/practice; and intellectual and professional
From these five components, cognitive skills and competencies can vary as a
result of differing levels of cognitive development. Perry (1970) proposed a four stage
cognitive developmental model similar to Piaget's Model of Cognitive Development. The
first stage is dualism/received knowledge (black or white thinking, no questioning of
authority. typical of young children); the second stage is multiplicity/subj ective
knowledge (truth determined by internal and subjective means by incorporating diverse
opinions, typical of early and middle adolescence): the third stage is relativism/
procedural knowledge (self-confidence in truth-seeking, doubting, discerning what is
right and wrong by supportable evidence, typical of postsecondary education); the fourth
stage is commitment-in-relativism/constructed knowledge (personal choices of truth after
evaluating options, information received through intuition and other people, high
tolerance for ambiguity, only some achieve this stage).
Redding (2001) states that there are five subprocesses involved with critical
judgment, all of which use the last two stages of cognitive development, problem solving,
caring, unbiased inquiry (relativism); intuition and reflection-in-action (commitment-in-
relativism). Redding (2001) postulates that clinical decision-making is not possible
without reaching the relativism/procedural development stage and the last stage of
commitment-in-relativism/constructed knowledge allows the practitioner to go more in
depth with his/her decisions. Redding (2001 ) claims that caring is a function of empathy,
which forms the basis of the nurse's intuition and unbiased inquiry is the basis of
reflection-in-action (if in the final stage of cognitive development). Intuition, according
to Redding (2001), is "the ability to internally sense that a certain choice or decision is
contextually correct without necessarily being able to clearly describe how that sensation
is supported .. [and is] generally more accurate in the experienced nurse" (p. 62).
From Redding's (2001) descriptions of clinical judgment and cognitive
development, intuitive skills only develop in some practitioners, as a function of their
empathic skills and cognitive development leading to advanced critical thinking skills. As
clinical decision-making is similar in both nursing and counseling, one could infer that
the same applies for counseling intuition; i.e., it is a function of empathy and cognitive
development and indicative of advanced critical thinking skills.
Clinical Intuition Research in Nursing
Investigating the use of intuitive judgments in clinical assessments of mental
health nurses, Welsh and Lyons (2001, p. 299) defined intuitive judgment in clinical
assessment as "the ability to 'sense' when something is not as it appears to be." The
authors contend that intuitive judgments are part of Schain's (1983) concept of reflection-
in-action and that expertise involves a tacit knowledge base from which we draw intuitive
judgments. Welsh & Lyons (2001) conducted a qualitative case study/content analysis,
interviewing 8 staff nurses at a psychiatric assessment and short-term treatment center
about their clinical judgments regarding cases over a six-month period. The authors
hypothesized that nurses would rely on their formal and expert knowledge base (and thus
their intuition/tacit knowledge) when faced with complex patient issues, to aid risk
assessment and to develop treatment plans.
Three themes emerged from their content analysis: research evidence (formal
knowledge and its limitations), tacit knowledge (formal knowledge and expertise
combined), and advanced practitioner skills (a combination of tacit knowledge and
intuition). Welsh and Lyons (2001) concluded that in making clinical assessments, expert
nurses will 'sense' when the research evidence for a particular therapy is lacking or not
working, bypass linear thinking, and quickly link into his/her tacit knowledge base
accumulated through expertise, and accessed through intuition.
No study limitations were discussed in the article, but it appears that Welsh's and
Lyons' (2001 ) themes must be further studied as they might suffer from some of the
cognitive errors in logical analysis. In qualitative studies, the researchers are the research
instruments and it is apparent from their tone that Welsh and Lyons strongly believe in
the validity of intuition and tacit knowledge in making clinical decisions. Consequently,
without outside confirmation of their emergent themes (which was not discussed), Welsh
and Lyons could suffer from the confirmation bias, searching for evidence in the
interviews to support their hypothesis.
In landmark studies exploring intuition in the nursing, feld, Benner (1984/2001)
and Benner and Tanner (1987) found links between intuitive abilities, expertise, and level
of experience in nurses. Benner (1 984/2001 ) describes a five-stage model of skill
acquisition for nurses ranging from novice to expert where experts are more able to
recognize patterns from a variety of independent, distinct stimuli acting together to form
a whole. Benner (1984/2001) postulates that this pattern recognition may be what is
actually occurring with intuitive processes and tacit knowing in nurses' clinical
judgments. The concept of pattern recognition distinguishes the intuitive abilities of
expert nurses from beginners and implies intuition does not occur until nurses become
experts (Perry, 2000).
Additionally, Benner and Tanner (1987) describe the process of and how nurses
use clinical intuition in practice. From 21 interviews with expert nurses, Benner and
Tanner (1987) described six ways expert nurses use intuition: "pattern recogmition,
similarity recognition, commonsense understanding, skilled know-how, sense of salience,
and deliberate rationality" (p. 23). Pattern recognition allows an expert nurse to see
relationships between events or symptoms without knowing the specifics components of
a situation whereas similarity recognition is recognizing patterns from previous
experiences (and thus comparing how similar one pattern is to another). Commonsense
understanding is the skill involved with being so familiar with the language and culture of
the field that the nurse is able to pick up subtle cues that appear to go against common
sense but in reality, are correct indicators of subtle illness. Skilled know-how allows
nurses to rely on their deep understanding and the second-hand nature aspect of their
work to feel out the correct way to care for patients. When expert nurses can quickly sum
up various situations, distinguishing between serious and not serious patient
circumstances/illnesses, the nurse is said to have a sense of salience. Finally, deliberate
rationality is the expert nurse's ability to question rational assumptions and seek out
alternative explanations for a patient's circumstances when something does not appear to
be "right" (Benner & Tanner, 1987).
Contradicting Benner and Tanner's concept that only expert nurses use clinical
intuition is a study of undergraduate senior year nursing students by Brooks and Thomas
(1997). Conducting a descriptive, exploratory, qualitative study of structured interviews,
Brooks and Thomas (1997) investigated the decision-making processes of senior
undergraduate nursing students in a 'clinical' situation. Each student was given a clinical
vignette describing a patient. The nursing students were then interviewed as to how they
conceptualized and approached the patient and his treatment. Results suggest that all 18
students approached the vignette differently, citing several different intrapersonal
characteristics influencing decision-making (such as experience, personal values and
beliefs, culture and lifestyle, etc.). All students shared only one characteristic: all
responses perceived and judged the vignette through 'personal knowing' or
understanding the situation from the perspective of the subject's own unique self; the
student nurses knew what to do and knew what was expected, separate from their
education and experience. The concept of personal knowing is very similar to the
definition of intuition as an unconscious means of gaining information or knowledge.
Brooks and Thomas' (1997) study further suggests that even beginning student nurses
used intuition in their clinical decision-making, diagnoses, and treatments.
Clinical Intuition Research in Medicine
Despite the myriad articles in nursing supporting the use of intuition in clinical
situations, the medical literature has relatively f~ew articles promoting the use of intuitive
clinical decision-making. This is not surprising, considering the scientific, logical, and
rational emphasis in modern medicine. However, there is one study indicating that
doctors do use intuition in uncertain and potentially serious situations with patients
(Brennan, Somerset, Granier, Fahey, and Heyderman, 2003).
Brennan et al. (2003) conducted a qualitative study of how 26 general
practitioners diagnose and determine nebulous presenting symptomology in children with
possible meningitis. In reaching a diagnosis of meningitis (and/or septicemia), the doctors
discussed how they rarely see presenting cases of the disorders but knew that the
disorders seldom presented in a typical fashion. Being unfamiliar and uncertain with a
serious disease such as meningitis, Brennan et al. (2003) describe that the doctors "relied
upon intuitive rather than systematic methods to distinguish serious illnesses from those
that are self-limiting. Doctors frequently relied on gut feeling or intuition to identify
illnesses that are potentially serious" (p. 628). The doctors also reported, however, that
because of the non-systematic means of diagnosis, many doctors commented that they set
up "safety nets" (Brennan et al., 2003, p. 628) to cover themselves should their intuitive
judgments be incorrect. Finally, the participants in the Brennan et al. (2003) study
indicated that specific guidelines for diagnosis and treatment "depersonalize [sic] the
doctor-patient relationship, exclude intuitive methods of diagnosis and undervalue the
role of experience" (p.629).
There were several limitations of the current reported by Brennan et al. (2003):
potential researcher bias, miscategorization of data, and misinterpretation of themes.
However, these limitations are only limitations when examining a qualitative study with a
quantitative lens. Again, this de-valuing of qualitative methodology because it is "biased"
in an objectivist field like medicine is also representative of why intuitive clinical
decisions are not openly trusted. From all research, there is always the potential for
researcher bias; in qualitative research, these biases are acknowledged, made explicit and
attempts are made to keep the bias from affecting the analyses.
In the Brennan et al. (2003) study, there are some limitations from a purely
qualitative perspective. Brennan et al (2003) did not specifically state their biases, as is
the norm in qualitative research, to allow the reader to judge the trustworthiness of the
conclusions. As such, this exclusion is a limitation of the research. One final limitation of
the study is that no specific analysis method is discussed. Brennan et al. (2003) discuss
doing interviews and finding themes, but good qualitative research is explicit about the
ontology, epistemology, methodology, and methods used to collect and analyze data
Clinical Intuition and Emotional Recognition
Counselors work with peoples' emotions and identifying these emotions is one of
the primary requirements for good counseling. As humans, we constantly read other
people's emotions and thus are usually quite good at distinguishing between various
emotional states. Does this emotional recognition improve with training and education?
Although there is no specific literature on intuitive emotional recognition in counseling,
there was one study examining how naive coders with no training compare with trained
coders in determining different emotional expressions (Waldinger, Schulz, Hauser, Allen
and Crowell, 2004).
Waldinger et al. (2004) investigated the prediction of emotions and marital
satisfaction between married couples' emotional expression. A third hypothesis examined
how naive, untrained coders of the couples' emotions compared to specifically trained
coders (following a detailed rubric) of emotions. Waldinger et al. (2004) believed that
nalve coders would identify similar emotions as those with a guideline and training
because identifying emotional cues in innate and intuitive in nature. As a result,
Waldinger et al. (2004) postulated that the intuitive nature of reading emotions would
enable the nalve coders to be as or more productive in distinguishing emotions than the
trained coders who must follow specific guidelines (and thus, ignore their intuitions).
Results indicated that nalve coders were consistent with the trained coders in identifying
emotions and that the nalve coders picked up emotional intensity more frequently than
did the trained coders (Waldinger et al., 2004).
One limitation of the Waldinger et al. (2004) study is that they used a relatively
small sample size for a factor analysis (N=47). Because of the small sample size, results
must be viewed with caution and more studies are needed to determine the reliability of
results. Despite this limitation, the results do indicate that the act of reading emotions is
intuitive by our human nature (Waldinger et al., 2004) and may therefore indicate how
some counselors use intuition in clinical decision-making.
Brief Explanation of Grounded Theory
Before I discuss the specific elements of the methods in my study, I would like to
give you an overview of grounded theory analysis. I outline how I plan to specifically
apply grounded theory in my study following this brief explanation of the important
components of grounded theory.
All grounded theory data collection and analysis is fueled by the constant
comparative method (Glaser & Strauss, I967), which Strauss and Corbin (1998) later call
comparative analysis, an analytical tool. With this method of microanalysis, the
researcher continually makes theoretical comparisons between and within data, incidents,
indicators, contexts, concepts, codes, and categories to delineate the processes,
dimensions, properties, and variations of each under different conditions (i.e., the
different participants' experiences) (Charmaz, 1983; Glaser & Strauss, 1967; Strauss,
1987; Strauss & Corbin, 1998). Constant comparisons are done at all levels of coding and
analysis (Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978;
Glaser & Strauss, I967; Strauss, 1987).
Comparative analysis/the constant comparative method does not merely describe
the different dimensions or properties of the developing concepts and categories; it also
analyzes the similarities and differences within and between concepts and categories
(Charmaz, 2000; Glaser & Strauss, 1967; Strauss, 1987: Strauss & Corbin, 1998). Glaser
and Strauss (1967) discuss the comparing of incident to incident; i.e., comparing the
dimensions and properties of each incident to one another to elucidate the categories and
theory. Strauss and Corbin (1998) elaborate with the idea of theoretical comparisons.
According to Strauss and Corbin (1998), "we not only speak of comparing incident to
incident to classify them, but we also make use of what we call theoretical comparisons
[their italics] to stimulate our thinking about properties and dimensions and to direct our
theoretical sampling" (p. 78).
Theoretical comparisons use the similarities, differences, and/or varying degrees
of the incidents' properties as tools to better understand the data (Strauss & Corbin,
1998). For example, if I want to initially interview three counselors, then I will compare
and contrast my participants, letting the data guide the comparisons. Furthering the
example, if level of experience emerges as an important component for counselors to
construct meaning of the clinical intuition, I can then group my participants into two
categories: experienced counselors and inexperienced counselors. I would theoretically
compare them by examining what it means to be experienced or inexperienced, how
counselors think/act/counsel when inexperienced or experienced, etc. and then compare
the "answers" from each category to each other to further the theory construction and
In qualitative research, participants are be recruited through purposeful, selective
sampling (Glesne. 1999; Kuzel, 1999). The different, specific qualitative methodologies
or methods sample purposefully using different procedures. Sampling in grounded theory
is guided by the emerging categories and themes in a process called theoretical sampling
(Charmaz. 1983; Charmaz, 1995; Charmaz, 2000;Charmaz, 2001; Glaser, 1978; Glaser &
Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Specifically, Strauss and Corbin
(1998) define theoretical sampling as:
Data gathering driven by concepts derived from the evolving theory and
based on the concept of 'making comparisons.' whose purpose is to go to
places, people, or events that will maximize opportunities to discover
variations among concepts and to densify categories in terms of their
properties and dimensions. (p. 201)
Theoretical sampling is flexible and is therefore not rigidly determined before
beginning the research to allow for maximum comparisons between concepts that emerge
from the analysis and to encourage creativity (Charmaz, 1983; Charmaz, 1995; Charmaz,
2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss &
Corbin, 1998). As a result, criteria for selecting participants will change with emerging
categories and interview questions will become more refined with each interview.
According to Strauss and Corbin (1998), "theoretical sampling is cumulative. Each event
sampled builds from and adds to previous data collection and analysis" (p. 203).
Although there is no rigidly followed procedure for recruiting participants in
theoretical sampling, it is also not a haphazard process of sampling anyone or anything
until the researcher whimsically decides to end his or her sampling procedure. In
grounded theory, sampling and analysis must occur simultaneously until no new
information emerges, a point called theoretical saturation (Charmaz, 1983; Charmaz,
1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss,
1987; Strauss & Corbin, 1998). Theoretical sampling must be consistent and systematic
to ensure that the data analysis and comparisons made are focusing the developing
theory. Initially, theoretical sampling gives the researcher a starting point; consequently,
the initial sample and interviews will be guided by several considerations. Strauss and
Corbin (1998) state that:
The initial decisions made about a project give the researcher a sense of
direction and a place from which to launch data gathering. What happens
once data collection is underway becomes a matter or how well the initial
decisions fit the reality of the data. Initial considerations include the
following: 1. A site or group to study must be chosen. .. 2. A decision
must be madet about the types of dalta to be used. .. 3. Another
consideration is howI long an area should be studied. .. -1. Initially,,
decisions regarding the number ofsite~s anrd observations and/or
interviews depend on access, available resources, researrch goals, and the
r~esearrcher 's time schedule andu energyi. [their italics] (p. 204)
Stages of Coding and Sampling
Grounded theory's analytic procedures can be useful to many different research
questions and different perspectives by building theories that allow the data to speak
(Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001). There are three main
phases of coding in grounded theory analysis: open, axial, and selective (Glaser, 1978;
Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Charmaz (1983; 1995;
2000; 2001) names the phases initial and focused coding, generally integrating axial
coding into the end of initial coding and into the beginning of focused coding. Each phase
has specific goals and is aimed at developing the emerging themes, processes,
relationships (between and within), dimensions, and properties of the theory to different
degrees. The purpose of theoretical sampling techniques differ as the coding becomes
more focused; starting out as open sampling in open coding, moving to relational and
variational sampling during axial coding, and ending with discriminate sampling in
selective coding (Strauss & Corbin, 1998).
Open coding and open sampling. In open coding, the researcher is interested in
starting to ground the data by broadly coding each data source, going line-by-line and
constantly comparing the basic codes and properties of the codes with each other to
discover concepts and categories (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001;
Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). According
to Strauss and Corbin (1998), during open coding, transcript data are "'broken down into
discrete parts, closely examined, and compared for similarities and differences. Events,
happenings, objects, and actions/interactions that are found to be conceptually similar in
nature or related in meaning are grouped together under more abstract concepts termed
'categories."' (p. 102).
After fully open-coding the transcript, you then group the open codes/categories
by the nature of their relationships and by forming hypotheses (axial coding). In axial
coding, the researcher further elaborates the dimensions, variations, processes,
relationships (between and within), and properties of each category by constantly
comparing more focused, incoming data to existing data to begin to see a broader theory.
At the beginning of a study, sampling is open (as is the coding) in that a
researcher is trying to maximize variation and information from the data and participants;
therefore, when sampling, a researcher in open coding may choose sites and participants
that will thus maximize variation and information. Since there are no developing
concepts, a researcher may use the existing field literature and/or her/his intuition to
guide participant selection (Glaser & Strauss, 1967; Strauss, 1987: Strauss & Corbin,
Axial coding and relational/variational sampling. As data collection continues
(with immediate data analysis), concepts begin to emerge that guide the next sampling
procedures. During the next phase of coding, axial coding, the researcher is trying to
make connections between and within emerging categories to specify the categories'
dimensions, properties, and ranges (Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987:
Strauss & Corbin, 1998). Strauss and Corbin (1998) define axial coding as "'the process
of relating categories to their subcategories, termed 'axial' because coding occurs around
the axis of a category, linking categories at the level of properties and dimensions" (p.
123). During axial coding, the researcher is concerned with examining the phenomenon
of study's structure (context) and process (actions/interaction over time and their
consequences) (Charmaz, 2001; Strauss & Corbin, 1998).
As a result, theoretical sampling at this stage involves the researcher sampling
participants or previously collected data who/that will give rich data about "incidents and
events .. that enable him or her to identify significant variations .. [by] comparing
incidents and events in terms of how these give density and variation to the concepts to
which they relate" (Strauss & Corbin, 1998, p. 210-211). This comparison is best done by
maximizing similarities and differences between participants and is done using intuition,
knowledge of participants, or persistence until the concepts emerge.
Selective coding and discriminate sampling. Finally, in selective coding, the
axial codes are grouped together into one "theoretical structure that enables us to form
new explanations about the nature of the phenomena."' (Strauss & Corbin, 1998, p. 103).
The goal of selective coding is to incorporate all of the categories' /concepts' dimensions,
properties, and relationships (between and within) to develop a cohesive theory and to
find where any holes in the theory might be. The data is rigorously compared with each
other and with very focused, incoming data to build a cohesive theory that is validated by
further data collection and constant comparison (Charmaz, 1983; Charmaz, 1995;
Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin,
Discriminate sampling, which occurs in selective coding is therefore, "highly
selective .. deliberate [sampling] .. that will maximize opportunities for comparative
analysis" (Strauss & Corbin, 1998, p. 21 1). During this phase of coding and sampling, the
researcher is rigorously and constantly comparing new incoming data to the current
data/theory and seeking new information when final validation or illumination is
necessary to reach theoretical saturation.
When further theoretical sampling, data collection, and data analysis fail to yield
any new theoretically relevant information, the researcher has reached theoretical
saturation and can stop further sampling, data collection, and analysis (Charmaz, 1983;
Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967;
Higginbottom, 2004; Strauss, 1987; Strauss & Corbin, 1998). According to Strauss and
Corbin (1998). "Saturation is more a matter or reaching the point in the research where
collecting additional data seems counterproductive; the 'new' that is uncovered does not
add that much more to the explanation at this time"' (p. 136).
Theoretical memos in grounded theory are analytic reflections by the researcher
related to the data, codes, and the developing theory (Charmaz, 1983; Charmaz, 1995;
Charmaz, 2000; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987;
Strauss & Corbin, 1998). Theoretical memos are the flesh and blood of grounded theory
analysis; they are where the analysis actually takes place. Theoretical memos are not
written to describe the data; they are written to analyze the data. (Glaser, 1978; Strauss &
Corbin, 1998). Theoretical memos force the researcher to focus on the data to help
develop the emerging concepts (Glaser, 1978). According to Glaser (1978):
The core stage [his italics] in the process of generating theory, the
bedrock of theory generation, its true product is the writing of theoretical
memos. If the analyst skips this step .. he [sic] is not [his italics] doing
grounded theory. Memos are the theorizing write-up of ideas about codes
and their relationships as they strike the analyst while coding [his italics].
Theoretical memos have four purposes/goals: working with ideas, allowing
freedom of thought, developing a memo bank, and easy sorting of the memo back
(Glaser, 1978). All researchers should write memos to conceptualize theoretical ideas
from the data, expand the properties of concepts and categories, present ideas about the
relationships between and within categories, integrate the different ideas/categories, and
compare the developing theory with already existing theories (Glaser, 1978). When
writing memos, researchers should keep an open mind and not judge what they are
writing to keep the ideas flowing (Glaser, 1978). Once memos are written, they should be
organized in an easily retrievable system that can be easily sorted into new arrangements
to aid with analysis (Glaser, 1978). Since memos are about the constant comparison of
the data's concepts and categories, they can also serve to direct theoretical sampling and
develop sensitivity to the data (Glaser, 1978)
Purpose of the Current Study
The purpose of this study is to better define and understand how counselors make
meaning and how counselors use that meaning of their clinical intuitions to help clients
by developing a preliminary theory of its use in counseling through a series of semi-
structured interviews with counselors (i.e., mental health counselors, marriage and family
therapists, school counselors, and counseling psychologists) that were analyzed using
grounded theory (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser
& Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998).
Despite the many divergent views of intuition and clinical intuition, there are
relatively few empirical studies discussing clinical intuition specifically in counseling. I
hope to better understand how counselors construct knowledge about their clients using
clinical intuition. I am investigating two main research questions based on the process
and meaning of clinically intuitive thought in counselors:
(1) How do counselors construct meaning of their clinical intuitions about clients?
(2) How do counselors use the constructed clinical intuitions to help their clients?
My study is exploratory, aimed at building an initial theory of clinical intuition in
counseling that is grounded in data. Ultimately, this study is one step in a longer
process of developing a thorough and broad theory of intuition in psychotherapy.
Theoretical Perspective Constructivism
Constructivism is the epistemological view that an individual constructs
knowledge and the meaning of reality through her or his individual mind (Crotty, 2003).
It is separate from social constructionism (social constructionism holds that meaning
making is an act of co-construction through interaction with another person or the
environment) in that constructivists hold that an individual constructs meaning through
his or her own mind (Crotty, 2003). Constructivism allows for flexible interpretations of
truth and knowledge that will differ according to the perceptions/meaning-
making/experiences of individual minds (Charmaz, 2000).
According to Schwandt (1994), constructivism is concerned with the first-hand
experiences of participants and is based on the idea that "what we take to be objective
knowledge and truth is the result of perspective. Knowledge and truth are created, not
discovered." (p. 125). Despite the relativist nature of constructivism, Schwandt (1 994)
posits that you can be a realist somewhat while still being constructivist in that
constructivists sometimes believe in an objective real world where ideas and concepts are
invented/constructed to correspond to something in said real world.
Guba and Lincoln (1994) state that constructivist inquiry is: (a) ontologically
relativist in that there are multiple realities that are the products of our individual minds;
(b) epistemologically transactional and subjectivist in that the researcher and object of
investigation co-create the findings together in transaction; and (c) is methodologically
hermeneutic and dialectical in that the "'individual constructions can be elicited between
and among [their italics] investigator and respondents" (p. 1 11) that are then
discussed/analyzed through comparison and contrasting to "`distill a consensus
construction that is more informed and sophisticated than any of the predecessor
constructions"' (p. 111). Constructivist inquiry is evaluated by how well the constructions
"'~fit' with the data and the information they encompass; the extent to which they 'work,'
that is, provide a credible level of understanding; and the extent to which they have
'relevance' and are modifiablee'" (Guba & Lincoln, 1989, p. 179).
As constructivism is theoretically concerned with the individual construction of
meaning and knowledge, I explored how individual counselors make meaning out of
clinical intuition. Clinical intuition is outside reason by its nature but worth
systematically studying to further our construction of knowledge. Because clinical
intuition is not fully described or understood, I worked within the constructivist
perspective to better describe counselors' perceptions of clinical intuition in counseling
based on the two research questions above. I used a constructivist theoretical framework
while conducting my research, hoping to fully describe and bring unity to the many
divergent experiences of clinical intuition.
Grounded Theory & Epistemological Consistency
The study's theoretical framework comes from constructivism (Charmaz, 2000;
Crotty, 2003; Lincoln & Guba, 1994b; Schwandt, 1994) and I used grounded theory
analysis techniques (Charmaz, 1983; Charmaz, 1995: Charmaz, 2000; Charmaz, 2001;
Glaser, 1978; Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998). Grounded
theory is epistemologically ambiguous to me. The original purpose of grounded theory
was to develop generalizable theory that is grounded in data using very systematic data
collection and analysis procedures (Charmaz, 2000). As a result, grounded theory is
rooted in positivism.
The most recent descriptions of grounded theory tend to describe the analysis in
more constructivist terms (Charmaz, 2000; Charmaz, 2001: Strauss & Corbin, 1998) and
that grounded theory methods appear to be compatible with constructivist inquiry
(Charmaz, 1983; Charmaz, 1995; Charmaz, 2000; Charmaz, 2001; Guba & Lincoln,
1989). The reflexive search for a common consensus of individual constructions that
describes the data better than any one alone seems very similar to the coding/analytical
process in grounded theory (Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin,
1998). Although grounded theory methods appear to be more positivist than other
qualitative methods (Glaser & Strauss, 1967; Strauss, 1987; Strauss & Corbin, 1998), its
adaptation to constructivist inquiry make it a suitable match for a constructivist
The epistemological confusion creates methodological difficulties for me as the
researcher. I tend to be much more constructivist when approaching knowledge and
inquiry. I also like the specific, proscribed nature of the techniques in grounded theory. If
1, as a constructivist, use an analysis method with positivist roots (grounded theory), will
my study be epistemologically consistent? I believe that because my roots as researcher
are constructivist, then I cannot help but apply the method in a constructivist fashion.
Grounded theory gives me tools and techniques during my analysis; however, my
analysis (as I am constructivist) ultimately has a constructivist flavor.
For my study, constructivist grounded theory is an appropriate analytic method
for several reasons. First, as I studied a non-rational topic like intuition, I believe having a
proscribed yet flexible set of procedures for data collection and analysis adds some
needed structure to the study. Secondly, using constructivist grounded theory allowed me
to construct themes and meanings while my participants constructed their own personal
meanings of clinical intuition while maintaining the structure that facilitated the analysis.
Finally, as I am intuitive and studying clinical intuition, using constructivist grounded
theory simply felt intuitively right to me.
Using grounded theory methods such as conducting interviews, theoretical
sampling, constant comparison, various coding strategies, and by writing theoretical
memos for my data collection and data analysis, I constructed a theory describing the
meaning of clinical intuition for my participants.
Initial theoretical samplinglopen sampling. I initially theoretically sampled and
recruited participants through criterion sampling (Kuzel, 1999). Criterion sampling
involves selecting participants that all meet some outlined criteria. As I am studying the
intuitive experiences of counselors (general psychotherapists). all participants met the
criteria of typical professional counselors/therapists: (a) are in the counseling field in
training, practice, or academia; (b) all participants held at least bachelor degrees and are
pursuing or have received advanced degrees in a counseling field; (c) all primarily
conduct relationship-based clinical practice; (d) all have had strong or frequent
experiences of intuition in counseling; and (e) are diverse according to years of
With participants who met all of the criteria, then I used the existing nursing
literature on clinical intuition and expertise as an additional criterion, to begin my sample
by interviewing, counselors with different levels of experience. I purposefully chose
intuitive counselors with varying years of experience (novices with 0-5 years
experience, intermediate counselors with 5-15 years experience, and experts with 15+
years experience) to set an initial foundation for theoretical sampling. I started by
interviewing one novice, one intermediate, and one expert counselor. I hoped to interview
a diverse sample in regards to gender, race, age, ethnicity, sexual orientation, and
disability but ended up with a fairly homogenous sample consisting of five white
participants, four of whom were female and one male. Based on the emerging themes, I
then sampled according to where the data pointed me by seeking information-rich cases.
To find information-rich cases, I used my insider knowledge of the participants'
degree programs, various students'/graduates' experiences in it, and the local counseling
community to choose participants whom I felt had a lot to say regarding my research
questions. Additionally, to further identify my subgroup of intuitive counselors, I asked
several faculty members in the University of Florida, Department of Counselor Education
and the University of Florida Counseling Center to identify several intuitive counselors or
intuitive counselors-in-training in the community, department, or state with varying
degrees of counseling experience.
In an attempt to further increase the diversity of my sample, I also recruited
participants through emails sent to counseling listserys asking those who self`-identify as
intuitive counselors to participate in my study. To determine the appropriateness of each
other-identified or self-identified intuitive counselor, I asked her/him to tell me a brief
description of how he/she regularly uses intuition in her/his counseling. I selected only
those self-identified intuitive counselors if they met the criteria above, if they appeared to
be information-rich cases based on their brief descriptions, and if they increased the
diversity of my sample.
Focused, relational/variational, and discriminate theoretical sampling. As
themes emerged, I sampled participants according to areas of my emerging
categories/theory that needed further elaboration, clarification, or explanation until no
new information emerged and I reached theoretical saturation (Charmaz, 1983; Charmaz.
1995; Charmaz, 2001; Glaser, 1978; Glaser & Strauss, 1967; Kuzel, 1999; Strauss, 1987:
Strauss & Corbin, 1998).
I felt two participants in my initial sample were information-rich cases for the
categories I was trying to elucidate and contacted them for one further interview each
(Woody and Katie). I needed new participants to illuminate my emerging themes and
recruited new participants primarily through asking counseling faculty for counselors or
counselors-in-training who would elucidate my emerging themes. One new participant
volunteered for the study and was from a different educational background, so I included
her in my sample (Jera). I interviewed one of the private practitioners (Molly) suggested
by a counselor education professor and found my data saturating after her interview.
After a result, no further sampling occurred.
My total sample included five interviewees (two participants were interviewed
twice and three were interviewed once), as determined by when I reached theoretical
saturation (Charmaz, 1983; Charmaz, 1995; Charmaz, 2001; Glaser, 1978; Glaser &
Strauss, 1967; Kuzel, 1999; Strauss, 1987; Strauss & Corbin, 1998). The exact number of
interviews and interviewees was decided during the data collection and data analysis
process, when I felt that further sampling was not necessary based on the saturation of
Interviewing counselors with varying degrees of counseling experience (0-5 yrs,
5-15 yrs, 15+t yrs experience), the participants held bachelor's degrees to doctorates and
ranged in age from 30 years to 80 years. I attempted to initially interview people with
different demographic information but the diversity I sought ended up primarily as
diversity of training and years of experience. To protect my participants' anonymity. I
asked all participants to choose a pseudonym (Woody, Katie, Jera, & Molly) and gave a
pseudonym to one participant who could not come up with one (Alice). I asked my
participants if they would prefer I kept some of their non-essential demographic data
confidential by broadening terms when reporting their data. No one clearly indicated that
they preferred me to change identifying information; however, if I felt that something
would identify my participant, I changed the non-essential information (such as places of
work and distinct, named experiences in the community).
Woody is a 34 year old, white male, PhD candidate in a Counselor Education
program at a large Southeastern United States university. His specialty track is school
counseling. Woody has a total of 6 to 7 years experience counseling, both in full-time
work and during his master's and PhD training. Woody is currently working as a
counselor in a university counseling setting. I conducted one initial and one follow-up
interview with Woody. Woody was the first participant I interviewed and as I collected
more data, I wanted to investigate how his experiences matched my newly emergent
codes. Consequently, I interviewed him again four months after our initial interview.
Katie is a 54 year old white female counselor holding a doctorate in Counselor
Education (specializing in mental health counseling) from a large university in the
Southeastern United States. Katie has a total of 15 to 17 years counseling, including her
years prior to going back for her doctorate. Katie is currently seeing clients in a private
practice. I conducted one initial and one follow-up interview with Katie. She was my
second participant and like with Woody, as I collected more data, I wanted to investigate
how her experiences matched my newly emergent codes. Consequently, I interviewed her
again five months after our initial interview.
Alice is a 33 year old white female student in an MEd/EdS program in Counselor
Education at a large university in the Southeastern United States. She is currently in her
second year of coursework, is specializing in mental health counseling and has a total of
1.5 years experience in counseling. I conducted one initial interview with Alice.
Jera is a 30 year old white female PhD candidate in a Counseling Psychology
program at a large Southeastern United States university. She is currently working on her
dissertation and completing her APA-approved internship. Jera has a total of 5 to 6 years
counseling experience. I conducted one initial interview with Jera.
Molly is an 80 year old white female counselor holding a doctorate in Counselor
Education from a large university in the Southeastern United States. Molly has a total of
30 +t years of counseling experience. Molly has a private counseling practice and directs a
training program for counselors in specific theoretical applications of counseling. I
conducted one initial interview with Molly.
Data Collection Procedure/Interviews
I initially conducted three (one novice counselor, one intermediate counselor, and
one expert counselor) individual, semi-structured interviews with my participants in
private locations within their academic departments or their offices. I explained that our
conversations will be audio-taped but they were free at any time to turn off the tape and
stop recording. I described the nature of the study to each participant and gave them the
informed consents to read and sign. I also informed each participant that this study is for
my dissertation and it will be presented and potentially published. There were eight initial
interview questions, with flexibility to probe for more information, should the need arise
(please see Appendix A). As categories emerged during simultaneous analysis, the
interview questions changed in the direction of the data, making a total of 1 1 initial
interview questions (please see Appendix B) for new interviewees (Jera & Molly) and 5
follow-up questions for those two participants (please see Appendix C) I met with again
(Woody & Katie). Each interview lasted between 35-90 minutes.
After completing each interview, I transcribed the interviews from the audiotapes.
After each interview and throughout the analysis procedure, I made reflective notes and
theoretical memos about my reactions to the interviews, comments/questions that arose
for me, and my thoughts/ideas about the data analysis procedures and content. As my
study is based on developing and grounding a theory from data, interview questions
evolved during the research process. Analysis of data occurred throughout the data
collection process, going more in-depth with interview questions and emerging themes.
Participants indicated that the interviews were helpful for them to put their
clinical intuition, which they usually do not think about, into words. All interviews went
well, although there were times when I felt that I was not asking questions in a way to get
at the information. Occasionally, I had reactions to the data, agreeing with what the
participants stated or having it trigger some negative reaction in me. When those
emotional reactions occurred for me, I wrote about them and worked through them by
Validity and Reliability
There is debate regarding validity and reliability in qualitative research.
Traditionally, positivist and empiricist research tends to evaluate the rigor of a study
through examining its reliability and validity (Kirk & Miller, 1986). In positivism, if we
measure something consistently and get the same results (reliability), then we can feel
more confident that we are getting close to the true nature of the phenomenon (Kirk &
Miller, 1986). Furthermore, if we have high validity, then we can feel confident that we
are measuring the actual true nature of a phenomenon (Kirk & Miller, 1986).
Since qualitative research tends to move away from the positivist epistemology of
holding that there is an absolute truth that we can objectively measure and evaluate, then
using the positivist measures of good scholarship and science do not fit well with these
different epistemologies in qualitative research (Angen, 2000; Denzin & Lincoln, 1994a;
Giorgi, 2002; Kirk & Miller, 1986; Lincoln & Denzin, 2000). Qualitative researchers are
re-defining how to assess rigor in qualitative research with its unique characteristics
(Angen, 2000; Giorgi, 2002; Kirk & Miller, 1986; Lincoln & Denzin, 2000). Depending
on the epistemology used by the researcher, these methods of insuring rigor can vary
(Angen, 2000; Giorgi, 2002; Lincoln & Denzin, 2000) but ultimately are there to try and
bring voice to the participants' stories and that the writing was not solely the author's
biased interpretation (Richardson, 2000).
Instead of using the terms reliability and validity, qualitative researchers discuss
rigor in different terms like trustworthiness (whether we as readers can trust the
researcher' s interpretations of their participants' voices) and credibility (whether we as
readers find the researchers' conclusions reasonable) (Angen, 2000). To help readers trust
and find results credible, different researchers are going to take different approaches
(Giorgi, 2002; Denzin & Lincoln, 1994a). For example, some authors recommend
triangulating data, which is a method aimed at using different ways to locate the data by
coming at it from multiple points of view, to increase trustworthiness and credibility in a
study (Denzin, 1978, Glesne, 1999; Lincoln & Guba, 1985). Others recommend stating
your subjectivities in your writing, using your writing as an additional method of inquiry,
keeping a strict audit trail, member checking, writing theoretical memos to increase the
rigor of a study (Denzin & Lincoln, 2000; Glaser, 1978; Glesne, 1999; Richardson, 2000;
Strauss & Corbin, 1998).
In my study, from a constructivist viewpoint, I do not believe we can truly be
objective since there is no absolute truth or knowledge. However, I still attempted to best
represent my participants' constructions of clinical intuition in counseling by using a
variety of methods to ensure that I was accurately representing their voices in my
To do so, I chose counselors from multiple sites (triangulation), wrote and
analyzed my theoretical notes/memos/journal from my observations and consistently
reflected upon my biases as a researcher, conducted more than one interview with some
participants. asking several peers to "'audit" my coding strategies, themes, and transcripts.
I also kept a strict paper trail of information regarding when I met with my participants,
how I reacted to their interviews, my analytical memos, and how I transcribed their data.
Finally, I gave my transcripts to and discussed preliminary results with my participants,
trying to ensure that their voices were accurately represented.
Theoretical Memo Writing
At each stage of coding and analysis, I wrote theoretical memos. My theoretical
memos became more focused on theory and comparisons of the data throughout the
analysis. Initially, I wrote memos about working through confusion or uncertainty,
extracting meaning from the data, and putting my thoughts together to form concepts and
categories. In axial coding, my theoretical memos focused more on the process,
dimensions, and relationships within and between categories (looking at the contexts,
actions/interactions, and consequences of the different concepts). During selective
coding, I wrote memos aimed at clarifying and illuminating gaps in my developing
theory, working out final confusion or uncertainty, and the constant comparisons between
my very focused incoming data with my theory.
I initially open coded each transcript broadly by underlining and coding phrases
that describe the participants' experiences with intuition. I then open coded the transcripts
more specifically, constantly comparing phrases that frequently repeated, jumped out at
me, were common to more than one transcript, or were different across the transcripts
(constant comparison method). While open coding, I underlined, wrote in the margins of
the transcripts, and developed code lists of words or phrases of interest. Some initial open
codes were: Sense of Knowing; Usually Right; Thought; Vision; Speeds Up the Process
(in vivo code); Not Judgmental; Helps Client Feel Understood; Trust Intuition More; and
Subtle Sharing of Intuition.
Once I completed open coding (through my reflexive notes, theoretical memos,
and the constant comparative method), several axial codes (themes and/or categories)
emerged that began to describe and integrate the data. The axial codes that described the
data were: Sense of Knowing/Connection/Awareness; Spontaneity of Intuition; Using
Tentative Phrasing; Using Respectful Phrasing; Checking Out Intuition; Comfort in
Being Wrong; Belief that Intuition is Right; Therapeutic Change; Recognized in the
Moment; Recognized after the Session; Receiving Intuition in Different Modes; Positive
Attitude of Counselor; Negative Clients: Expression of Intuition: Strength of
Relationship with Client; Quality of Relationship with Client; Increased Confidence with
Experience; Trust of Intuition with Experience; Rapport; and Being Fully Present. Using
different color highlighters denoting each of the above axial codes, I then went back
through the transcripts highlighting words and/or phrases that fell into the separate
categories. I also grouped the open codes from my separate code lists into each of the
axial code categories.
I continued to write analytical memos during this stage of analysis to further
develop the emerging categories from new data collection. My memos in axial coding
were much more theoretical than the beginning open coding memos (please see Appendix
D). As the data began to frequently repeat, I was eliminated some axial codes and
proceeded to the next stage of analysis.
Continuing to write memos, during selective coding, I further refined and
synthesized the axial codes. The codes that appeared most frequently and were at the core
of how counselors make and use meaning of clinical intuition in counseling became my
selective codes: Recognizing & Receiving the Intuition: Sense of Knowing or
Awareness; Tentative and Respectful Expression of Intuition: The Counseling
Relationship; and Therapeutic Change.
From these selective codes, I integrated them into a core category (which became
my theory statement) that best described how counselors use and make meaning of
intuition in counseling. I then verified my emergent theory by constantly comparing the
theory with old data and newly collected data to fill in the theory's gaps. When no new
information emerged during my first interview with my fifth interviewee (Molly), I
completed my analysis and developed a theory figure to offer a visual representation of
The theory that developed from my data analysis is: Counselors construct
meaning of clinical intuition as a sense of knowing or awareness about clients, resulting
from the counseling relationship, that they then communicate to the client, benefiting the
counseling process. The theory incorporates elements of defining what intuition is and
how the counselors receive or recognize it as intuition, the importance and cyclical nature
of the counseling relationship in generating clinical intuition, how counselors
communicate the intuitions to their clients, and also the boundaries and benefits of using
Figure 1 illustrates the important elements of the theory in context with each
other. The three central elements to the theory are the client. the counselor, and the
intuition, which are all connected by the counseling relationship. If a client is too
negative, too unhealthy, or not available to the counseling process, then a boundary from
the client's side keeps the relationship from truly forming and thus does not generate
clinical intuition for the counselor. Likewise, if a counselor has a negative emotional
reaction to a client, then a boundary from the counselor's side keeps the relationship from
truly forming and thus does not generate clinical intuition for the counselor. If these
boundaries do not occur in session, then a sense of rapport, a sense of connection and a
sense of presence with the client help create a positive counseling relationship, which
helps generate intuitions for the counselor.
Boundary to Process
ion to Client
Bound r o
Boundary to Process
Cl too 'unhealthv'
Figure 1. Theoretical Model of Clinical Intuition In Counseling
A counselor's level of experience influences how they trust using intuition in a
session which also impacts how comfortable they are receiving and recognizing the
intuition. After trusting, recognizing, and receiving the intuition through a variety of
ways, the counselor usually believes that the clinical intuition is correct, thus giving them
a sense that they are right. Concerned about the relationship, the counselor will
communicate the intuition in a tentative and respectful way, giving the client safety to
disagree, and also are willing to be proven wrong. This way of communicating the
intuition improves the counseling relationship, thus creating more opportunities for
clinical intuition in the counselor.
After communicating the intuition, the benefits of intuition can then start creating
positive change for the client. Usually these benefits help the client gain meaning from
the intuition, create a turning point for the client, and/or speed up the counseling process.
All of these benefits help move the client toward therapeutic change, ultimately
impacting the outcome of therapy in a positive way.
Defining Clinical Intuition
All participants referred to intuition in counseling as either a sense of knowing
(Katie, Alice, Jera) or an awareness (Woody, Molly) that they recognize as being relevant
to the client but without knowing how they know the information. Despite the intangible
nature of the sense of knowing, all participants indicated that when they recognized the
intuition as for their client, it was nearly always correct or on target when they followed
up on the insight with the client. Furthermore, although all participants trusted their
intuition, there seemed to be a difference in comfort level and confidence level in using
their intuitions with their clients for the novice, intermediate and expert counselors.
Receiving and Recognizing the Intuition
Although all participants indicated that they recognize an intuition as being for
their client, the modalities for that receiving and recognition varied for some participants.
All participants but Katie described the intuition as primarily coming though as a
feeling/bodily sensation that they translated into words to make meaning for the client.
Katie received and recognized her sense of knowing through several different modes
depending on the client and sometimes occurs as a feeling of being "driven to do
something." Katie described that she frequently receives intuitive information as
thoughts. For Katie, "A thought. .. Or the thought that this poem would be good for that
client. So it comes.... It definitely is a thought."
All of the modalities for receiving and recognizing intuition link well with how
intuition is written about in popular and scholarly literature (Day, 1996; Goldberg, 1983;
Naparstek. 1997; Petitmengin-Peugot, 1999) in that it can be recognized through
clairsentience (sensing or feeling an intuition kinesthetically or emotionally),
clairvoyance (seeing a vision or image that corresponds to a sense of knowing), or
clairaudience (hearing or thinking intuitive information).
Katie and Jera also receive and recognize the sense of knowing across several
modalities. Although Katie refers to it as a thought most of the time, she also refers to it
as "sense or see or vision somehow what they were trying to say before they even said
it." Jera also described seeing "'very vivid mental pictures of something that I feel
expresses what the client might be experiencing." However, Jera also receives and
recognizes intuitive information through feeling that something is for her client; for
example, she stated "it's like a feeling that you just know." Jera never specifically
described receiving or recognizing the intuition as a bodily sensation, although she does
mention that when she is not using her intuition in a session that she is "sort out of out
my body, in my head."
Woody described that he typically recognizes clinical intuition as an emotional
feeling that occurs in the moment that helps him figure out if a client is being
forthcoming, what the client might be feeling, or what might come next from the client.
According to Woody, "Feeling. Definitely feeling. .. I feel like my intuition is maybe
more attuned than a lot of people's. There are times I where I can just look at somebody
and tell what's going on. .. And it's definitely feeling. Definitely feeling." Once he gets
that feeling. Woody then translates it into a thought through his mind. Woody stated
"intuition means thinking or becoming aware of something that you're pretty sure about
but you wouldn't be able to confirm it unless you actually explore it."
Similarly to Woody in that he translates a feeling into thoughts, Alice and Molly
receive and recognize the intuition first in the body that they then translate into words
through the mind for the client. Unlike Jera and Woody, who use the word "feeling"' to
describe their recognition of intuition, Alice and Molly go beyond feeling and describe it
as a bodily sensation. Alice stated "And in the body, I would say, I just have a sense of it.
It triggers, I don't know, there's movement there. And then it goes directly to my mind. I
try to pull myself out of my mind, out of thinking." Molly described her intuition as
coming from "somewhere down in your diaphragm, along the power chakra, I think. It's
physical. It filters through the mind, everything has to come through the mind to put
words to it. It the genesis of it is not in the mind."
Additionally, nearly all participants but Katie described recognizing most of their
intuitions in the moment, during a session with a client. Although that occurs for Katie,
she tends to more frequently recognize the intervention as intuition when she reflects on
it after the session. Katie stated "'it's usually afterwards I realize it was intuition. I don't
really know it's intuition when it's happening."
Trusting of and Comfort in Using the Intuition
All participants indicated that they trusted their intuitions about clients; however
that trust and confidence in using their intuitions while counseling seemed to grow with
more experience. Alice, with the least amount of counseling experience, described herself
as still growing comfortable trusting intuition and knowing when to use it in a counseling
session. Molly, on the other end of the continuum with over 30 years of counseling
experience. indicated that she never questions whether the intuition is valid and brings it
into a counseling session frequently. The other participants tended to fall somewhere in
between Alice and Molly on the continuum. Despite the different levels of comfort and
trust regarding their clinical intuitions, all counselors seemed to describe that their
intuitions have not changed as they gained education and experience but the trusting of
and confidence in using grew.
For Alice, trusting and growing comfortable with her clinical intuition is
something that she is learning as she gets more experience. With one and a half years of
counseling experience, she is struggling with knowing when to share it with a client to
facilitate the counseling process. Alice stated "more often than not, never gets put in the
case notes, rarely even gets shared with the client. Because I just use the intuition as a
guide." Conceptualizing intuition as a guide for her work but not sharing it with clients,
Alice later stated that she thinks that's probably more about me and my level of
comfort in trusting the process. I sort of have this sense like I can't project onto my
clients that .. what may be their truth or not." Alice questions whether or not the
intuitions she regularly receives about the world and people is something she can bring
into a counseling session for fear of not wanting to impose on the client. As she
mentioned, she believes this will change as she grows more comfortable with the
counseling process, knowing what is okay to bring into sessions.
Molly confirms Alice's comments about her use of intuition when she first started
out counseling. Molly described that she has had to "educate my [her] sensing
capabilities, my observational sense. Because all my life, I've been very intuitive but I
didn't know `where did that come from?"' when she first began counseling. As she
gained experience and was in a different mindset than perhaps a novice like Alice, Molly
stated "I don't think my intuition has changed but I trust it more. Well, just with
experience and finding out what happens ifl come across with some really strong
intuition I have. I think it's just experience." Molly further described that acknowledging
or verifying her intuition is not necessary. According to Molly, "If I have it, I support it.
Jera stated that she is still growing comfortable using her intuitions with clients
but that has changed with her experience. She stated:
I think the basic change has not been so much the intuition but the
confidence level in using it. Because I think my first two or three years of
counseling, I did have these feelings but I wonder if this is what it is and if
this is what the client needs to be presented with.
According to Woody, he always has had the intuition but with experience, he learned
how to use it more in the counseling session. Woody described "the feelings have been
there all along but I know how to use them almost .. until we have some sort of minimal
formal training, we're not exactly sure what to do with what we're able to perceive."
Katie actually discussed that she might rely on her intuition less now than she did
starting out in the profession, as she now knows what to do from the knowledge she has
gained with education and experience. However, Katie states that the amount of intuition
she receives in counseling have "'realistically, it's stayed the same."' To explain the
difference in relying on her intuition less now, Katie described "Maybe I recognize them
a little more now than I did them. I was flying by my seat on intuition a lot more then
than I am now. But I don't know if it's changed." Katie tends to conceptualize her
clinical intuition as a wonderful surprise when it happens and does not tend to rely on it
in case that reliance turns it off. Despite not relying on it, Katie described frequent uses of
her clinical intuition but still questions her intuitions with clients. Katie stated '"it just
surprises me every time. It' s almost like 'Why won't I trust it?' It just happens and I'm
just grateful and then I just move on."
The Counseling Relationship
All participants mentioned that the counseling relationship with the client was the
most important factor for making meaning of a clinical intuition. Without it, most
participants claimed that there would be no intuition coming forth in the session. To be
able to develop a relationship with their clients, most participants described a need to be
present and engaged in the session with the client for their intuition to also become
Sense of rapport, connection and being present with the client. The clients
with whom the participants felt a strong sense of rapport in the counseling relationship
felt most present and engaged and thus recognized more intuitive insights about the
client. Without the sense of rapport or being present, most participants did not feel like
their intuition could engage. All participants mentioned that connection, rapport, and
presence as vital to intuition, although some of them discussed this important link in
terms of when it was lacking.
Jera stated .. where I am noticing some aversive personal habit, I feel like
there isn't really the rapport and the strength of relationship there to let the insight come."
Jera further goes on to add "Not really present. Not really open. That's what it feels like
to not be following my intuition." Woody stated "If you are comfortable enough .. with
a client, if you have a good rapport, if you meet for a few times or even if feel that
instance rapport, it s easy."
Alice, Katie, and Molly tend to describe that sense of being connected to the
client when the intuition comes into the session. Katie described ''energy passes between
us that passes along that sense of knowing. Their sense of knowing to me. So it becomes
a sense of knowing that I have about them." Katie goes on to further add "'intuition is a
process .. it isn't stagnant .. it goes from my client to me, from my client to me. ..
They're still in my mind, maybe even in my unconscious when something will come up
for me. So if I had not had the interaction with them .. there has to be something about
them that comes to me that triggers my intuition."
Molly describes it as "Nothing's going on if there is no contact. And that means
that we can't be in our heads, because nothing we think is ever present. We have to be in
our bodies, engaged with each other. And that's an intuitive process." Alice described the
connection with the client as "You're connecting with them as a human being and if you
are also tapping into the energy that they're presenting with." This is very similar to
Katie's and Molly's construction of connection and intuition with their clients.
Cyclical nature of intuition and the relationship. Not only did participants
indicate that the relationship was fundamental to their individual meaning-making of
clinical intuition with clients but the intuition also enhanced the relationship. For
participants, disclosing intuitions to their clients allowed the clients to feel more
understood which in turn further enhanced the counseling relationship. Woody stated "It
[the connection/relationship with a client] would probably enhance it [the intuition].
Because if you are making a connection, then you are probably on the right track and if
you are on the right track, the connection can get stronger. .. So it would probably
enhance the rapport."
For some participants, the connection between the counseling relationship and the
intuition made it important to gauge the appropriate time in disclosing that intuition. The
timing of disclosure was always linked back to making sure it was not going to hurt the
counseling relationship by determining the client's openness and readiness to accept the
intuition. Alice reported "when I feel very strongly about something that I don't feel is
going to jeopardize or harm the client, I will share it with them .. intuition is a very
subtle energy .. even though I am not taking responsibility for them, I'm taking
responsibility for what comes out of my mouth." Molly mentions that she "is very
cautious about what I do with my intuition, up to a point. And then at some point, I just
say 'Well, here it is kiddo' and I put it out .. [with] radical respect." Molly further goes
on to describe that she also uses her intuition in determining the time she puts another
intuitive insight out to the client.
Sometimes, the participants received intuitions about clients before they felt
enough of a sense of rapport with the client and were cautious that disclosing the intuition
could potentially hurt the relationship. Jera mentioned "if it is a really strong intuition, I
have to think about whether the client is ready for it. Because sometimes, I have the
intuition and the timing isn't right."
Communicating the Intuition
Similar to constructing the importance of the counseling relationship with
intuition, participants described disclosing intuitive insights to their clients in a very
respectful way, aimed at not hurting the strength of counseling relationship. The
participants disclosed intuitions using tentative phrasing, respectful questioning and were
always willing to be wrong so their clients could disagree with the intuition.
Tentative and Respectful Expression of the Intuition
All participants mentioned that they tend to use caution and respect when
disclosing an intuition for the client so as not to harm the counseling relationship. This
caution usually came out with clients as making a disclosure using language that was
very hesitant out of respect for the client and the counseling relationship. Woody
described this sense of phrasing as "'getting wiggle room" with a client, room to explore
an intuition without making it seem as though it is a certain statement of fact before
checking it out. Using an example of how he would disclose an intuition with a client,
Woody stated "I don't want to offend you, I don't want to scare you but I have something
in my mind and I want to check it out."
Woody further described the way he discloses and checks out intuitive
information with clients as being "very subtle"', which could also influence when he
decides to disclose insights to his clients. Woody also discusses frequently how the
intuition comes in service of the relationship and thus must be disclosed subtlely to not
damage the relationship. He stated that:
Sometimes I like students a lot. .. but the fact that I like them a lot,
might be a little more subtle about how I disclose because I don't want to
damage the relationship. .. and some counselors are like intuition, bam.
right in your face, this is what it is and you're wrong and you need to do
this and .. it might even be right. However, if the relationship is
damaged, how right were they?
For Woody, it seemed that having a pushy, overly arrogant attitude with disclosing an
intuition could damage the client and not be with sharing since it could harm the
counseling relationship and thus process.
Jera described a similar feeling to Woody in that she felt that she must assess how
the client will react to an intuition before sharing it and always stating it in such a way to
allow the client wiggle room. In an example of when she used intuition with a client, Jera
described how she shared the intuition with the client as "I said 'Right now, I'm getting
this really vivid image and it's very graphic and I wonder if it would be okay if I shared it
with you to get your reaction and see what you're thinking about this image I'm having."
By stating things in cautious language (1 wonder if, would it be okay if I shared it with
you), Jera phrased her intuition in a way to not harm the counseling relationship.
Alice also supports what Jera stated, adding that she is "always real careful about
how I say things. Try to be. .. There are times when I might just say "You know, I
kinda got this sense that X was happening with you." Alice used a powerful metaphor to
describe the respect for the client in sharing the intuition:
How can I best bring this [intuition] to the client? What ways are they
going to be receptive to it? Because if their receptivity is low, then what's
the point of sharing the intuition? So, for me, it's like getting a raw
diamond. It's beautiful but it's raw. It looks like a rock. So you get an
intuition. It's kind of the same thing and you say 'Now, how am I going to
cut, how am I going to work with the material? Because I can put some
cuts on that diamond and it's not gonna have any sparkle to it. The person
is going to look at it and say 'That's useless to me.' Go ahead and cut that
diamond in the right way and my god, it just blows you away how
beautiful it is. How much you see. It's the same thing.
Describing intuition as a raw diamond and cutting it for the client alludes to the idea that
for Alice, phrasing an intuition in the right (and respectful) way to the client allows for
the client to not feel defensive and get the most of the intuition.
Molly describes the tentative phrasing as being cautious and working with the
client's system in a respectful way when disclosing an intuition. For example, Molly
described what she might say to a client as "'This is coming to mind. I don't know if you
want to hear it but if you want to hear it, here it is. And I let them be the judge because it
is their system I am working with, not mine." By phrasing it a way using hesitant
language like "'I don't know" and "if you want to hear it," Molly is giving her clients the
wiggle room and respect to decide if they want to hear an intuition.
Katie uses tentative and respectful phrasing in general with clients but tends to
work the intuition into the flow of the session. For example, when describing a client she
worked with, Katie stated "You know, when I read this poem, your name popped into my
head and I just knew immediately this poem was perfect for you." Katie uses stronger
language but builds relationships with her clients that they can always disagree with what
she is saying so that disclosing the intuition is similar to how she reacts to clients
generally. However, with clients that she feels might not be ready to handle an intuition
or that it is in a touchy area, Katie stated "No, I wouldn't put it [the intuition] out. I saved
it. It also depends on how you put it."
Sense of Being Right
Since all participants stated that they phrase intuitive information respectfully and
cautiously, one reason for being so hesitant with disclosure is that they all feel their
intuitions are on target. Caring about the relationship and wanting to respect the client,
but feeling that their clinical intuition is by its nature correct, the participants phrased or
questioned clients regarding the intuition in such a way to allow the client the room for
escape if it was too much for them at a particular time or if it happened to be incorrect.
In describing their intuitions as being correct, participants stated it a variety of
ways. Molly reported that "intuition to come out into. it just does what it does. And in
my experience, it's right on target." Similarly to other participants, Katie referred to
disclosing her intuition as "just like let it out there. If I say to a client 'you seem to be
angry' they'll tell me if it's right or wrong. But the intuition is usually right, which is
amazing." Katie goes on further to reflect:
I only notice it as intuition because it has fallen into place. It if doesn't fall
into place. then I notice it but it was just a thought. You know, maybe
that's why people with intuition think they're always right. Because if it
doesn't fall into place, they don't notice it.
Katie's description indicates that when her intuition is not verified by the client, it was
Jera. Woody, and Alice use similar language to describe the same sense of being
right with their intuitions. Jera described it simply when discussing a client with whom
she shared an intuitive insight as "it did feel a little risky .. but I never thought 'what if
I'm wrong?"' Woody added "obviously if I find out that it's not the case, then I have to
change that. But in my experience, I'm usually not far off." Alice stated "It feels so right,
cellularly in your body. You just go 'Yes! '" indicating that her intuitions are correct most
of the time.
Willingness to be Wrong and Safety for the Client to Disagree
However, despite this sense that their intuitions are correct, all participants
discussed not assuming that the intuition was correct by wanting to check it out with the
client. They all check out an intuition with the client to make sure that the intuition had
meaning for the client and not just for the therapist. Additionally, this sense of acceptance
in being incorrect with the intuition also allowed for their clients to feel a sense of safety
in disagreeing with a disclosed intuitive insight, for the participants, creating this sense of
safety was vital to the process.
Molly described this not wanting to assume an intuition is correct when she stated
"it's my stuff and I always make that clear by just putting out 'This is me and I don't
know if it reverberates with you at all. And if not, just say so."' Katie referred to her
checking it out with the client and acceptance of being wrong as "I don't get turned down
too much or told that I'm wrong too often and plus I don't take it personally if I am
wrong." Alice also confirmed this by stating "Because number one, I'm okay with
rejection in that if they say 'No, that's not true for me."'
Using an example of how he would disclose an intuition with a client, Woody
stated "Now look, I might be wrong here and if I am, let me know." Jera also discussed
phrasing an intuition as "I1 wonder if" to give clients the room to disagree if they aren't
ready for it to come into the session. By phrasing their intuitive insights in such careful
ways, it creates comfort for the client to say if an intuition is incorrect. However, as
stated above, the client rarely disagrees with the counselors' expressed intuitions.
Boundaries and Benefits to Using Clinical Intuition
After communicating the intuition to their clients, usually the client moves in a
positive therapeutic direction. There are times, however, that the counselor does not
receive any intuition and thus does not get the benefit of using clinical intuition while
Boundaries that Disengage Intuition
All participants described certain instances when their intuition might not be
engaged in a session. These reasons for "'turning off the intuition'' participants mentioned
are: some clients are too negative (all of the counselors described themselves as positive
or optimistic), too deeply enmeshed in their difficulties, have an attitude of this is not
worth my time or effort, or who elicit an emotional reaction in the counselor. Usually,
these circumstances arose from something elicited in them by a client.
For some participants, like Jera or Woody, their intuition "turned off' when
clients or a counseling session tended to get their (as counselors) emotions engaged in a
negative way. For other participants, it was when the client was not available or open to
counseling (Molly) and/or if they were in a very dark, unhealthy place at the beginning of
counseling (Katie). Unlike the other participants, attributing the times their intuition was
not engaged, Alice stated that it is because of not being present in the room. Alice was
hesitant to attribute that lack of presence as reaction to a client although from her
description, it almost seems similar to Jera and Woody, somehow getting triggered
emotionally and therefore not fully engaged with the client.
Jera and Woody both described that their emotional reactions to a counseling
session or client would turn off their intuition. For Jera, she described the predominant
emotion as anxiety; for Woody, he describes frustration. Jera stated "it's been vitally
important to keep my anxiety as low as possible so that I can be open to listening to my
own intuition in the room. [The anxiety] definitely gets in the way." Woody discussed
that "sometimes a kid frustrates me .. then my intuition is not [engaged] .and then my
emotions have gotten involved because I'm really frustrated with what's going on."
Molly described finding it difficult to engage her intuition with clients that are not
open or available to counseling but relates that to not fully engaging as a counselor, and
not just the intuition, with those clients. She stated "Generally, I think I would say
availability. People come in and they think they want to work on stuff but all they really
want to do is just gorge, just dump." Those kinds of clients are difficult to engage in true
counseling to Molly and thus difficult to engage her intuition.
Katie also describes not being fully engaged with some clients, both with those
who are not open to counseling and also with those who are in very dark and unhealthy
space at the beginning of counseling. Katie stated that "I just think part of it is that
they're not open." Furthermore, she said while describing one client,
It's like he is suffering so much and he brings this aura with him. .. I do
have a sense of my energy, it's tough to push my energy to give that to him
a little bit and then to also have intuition working too. I don't know if it's
possible, when their energy is sooooo down and black.
For Katie, who described herself as a very positive person, the negative feelings coming
from the client tended to make her much more knowledge-based in her work since her
intuition did not engage. I have to do some real knowledge stuff with people who are
down. .. I don't think you engage as much. .. In my experience, the people who I see
and have intuitive moments and I reflect with and do that stuff, they're not down at the
bottom. They've moved."
Benefits of Using Clinical Intuition
In disclosing their intuitions with clients, not only are the participants "checking
out"' the intuition with the client's experience of an event but also helping the client gain
meaning from that event to move the client toward therapeutic change. Discussing an
accurate intuition that a client is ready to hear is a powerful moment in therapy, where
great movement occurs according to all participants. The interviewees frequently
described the disclosure of an intuition leading to a different level of therapeutic work in
the session, often leading to intense turning points and speeding up the therapeutic
Helping clients gain meaning of intuition. One of the first ways the participants
described using their intuitions to help the client move toward change was to help the
client make individual meaning out of the intuition. The therapist provided their
constructed meaning of an intuition almost as a cue for the client to respond to and draw
his or her own individual meaning from it.
In an example of when she used intuition with a client, Jera mentioned "The
image that I shared with her was very gory, very kind of graphic but it really cemented a
couple of insights that she had already come to and coalesced in the image that she was
then able to take that image with her." The intuitive image served almost as a trigger for
Jera' s client to be able to put everything together and construct her own individual
meaning from it that she could then take with her.
Alice stated that when she shares an intuition with a client, the client could "say
'Oh my god, yeah. Wow. That's happening for me. .. and it completely takes their little
window of how they perceive everything and shifts it just a little bit and suddenly, things
move in a different direction for them." The client makes individual meaning out of what
Alice presented and uses it to move to a different place therapeutically.
Katie described a time with a client when she saw an intense color and connected
it to the client. She said "Just like if you were doing a reflection of feeling or reflection of
meaning, they tell you. It's like the guy afterwards with the aquamarine said 'You know,
when you said aquamarine, I was seeing that color."' Katie brought her intuition of that
color into the session and then facilitated the client's individual meaning-making of the
Woody and Molly did not describe specific instances of helping their clients make
meaning of an intuition but throughout their interviews, the focus on checking it out with
the client implied to me that they also don't impose a meaning on an intuition. By not
imposing their own therapist's meaning on the intuition, they leave the intuition open to
the client's own meaning-making.
Creating turning points. The participants also described times in which working
with an intuition brought about a turning point for the client, either in the session or
afterward. However the common connection was that the therapist's intuition sparked a
change in the client (once they added their own individual meaning of it) that moved the
client to a different space therapeutically.
Katie described times when she did not directly disclose an intuition to a client
because it came to her as a need to do something. However, Katie ended up working with
the product to help the client gain meaning from the output of her clinical intuition. In
describing an example of this with a client, Katie said:
I felt I HAD to make her this hanging thing with beads and stuff and I
wanted to put an origami crane that I made on it. .. I just said "I made
you this. Take it to your next place you live."' And first off, she told me
red was her favorite color .. and that was it, I didn't hear from her. I
didn't think anything more about it. I had been driven to do it and then it
was over. About two years later, she wrote me an email and said "Your
origami crane has been hanging in my kitchen for the last two years and I
cannot tell you how much peace and solace and also how much it has
motivate me to do thing. And even though you aren't here, these are the
changes I've made in my life."
Katie's intuitive drive to make the crane ended up serving as a turning point for the
client; a constant reminder of where she wants to go and it gave her the peace and
motivation to move to a healthier place.
Woody described an instance working with a client when he received an intuition
that the client was using drugs, even though there was no indication of that in how she
presented. He stated "she would come and see me on a regular basis .. and she would
come in and she would talk about surface level stuff and I just flat out asked her 'How
often are you smoking marijuana?'" Allowing the client room to deny if she were using
marijuana, Woody used that intuition to confront the client. As a result, his intuitive
confrontation served as a turning point where they got off the surface level information
and then started doing real therapeutic work.
Jera described how she frequently sees her intuition in sessions to know what will
create turning points for her clients. She discussed:
Often at some point, I will just know they are going to turn a corner and I
will be so looking forward to their next session. Because my intuition tells
me that their readiness is peaked and they have the insight they need and
their motivation level is high and this is going to be the week.
For Jera, her intuitions can help her know when to use certain techniques or
confrontations because she intuitively knows the client is really for the challenge and thus
a turning point occurs. Similarly, Molly did not mention a specific example with a client,
but implied that her intuition "'gives me all the raw materials to use in coming up with
interventions."' As a result of those interventions, she helps her clients come to turning
Speeding up the counseling process. Using their intuitions in counseling, the
participants also described how it allows them to speed up the process of counseling. As
with helping a client gain their own meaning and by reaching turning points, the using the
intuition ";as a guide" (Alice) or to help get to those turning points faster (Molly, Jera,
Woody, & Katie), the intuitive insights about clients move them toward change quickly.
Jera stated "it speeds things up so much." Woody described his clinical intuition as
"'We're wasting time and the intuition is a way to speed up the process."' Molly, Alice,
and Katie all implied that their intuitions help them get to the heart of a client's issue
more quickly without specifically stating it.
IMPLICATIONS & CONCLUSIONS
Reflections on the Research Process
Interestingly, my experiences with clinical intuition are somewhat different than
my participants' experiences and by conducting research for this dissertation, I feel my
individual construction of intuition has changed. My own subjectivity created moments
when I was genuinely surprised that the analysis was taking something in a very different
direction than how I have personally experienced it. There were very many similarities: I
also would describe it as a sense of knowing or an awareness about a client that I
respectfully and tentatively express to a client to help move him/her toward therapeutic
change. I also use my intuition to determine appropriate interventions and the timing of
those interventions as some of my participants described. The main difference is that I
have never considered the counseling relationship to be an important aspect to intuition.
For me, intuition never seemed to result from having a strong rapport with a client,
although it certainly helped me feel more comfortable communicating an intuition to a
Before starting this research, I never considered the counseling relationship to be
a vital factor because I never stopped to consider how I experience intuition differently
while counseling than in the rest of my life. As I have had intuitions about people I have
not had any contact with before, not having any sort of relationship with that person, I
assumed that this was the case in counseling. However, after listening to my participants
and analyzing their individualized constructions of clinical intuition, I started to
acknowledge that the counseling relationship has been vital for my own experiences with
clinical intuition. I cannot recall an instance when I received intuition about a client when
I was not engaged, fostering, and using the counseling relationship is some sense.
I also found myself agreeing with my participants as to times when my intuition
has not been engaged in counseling, usually with very gloomy or unhealthy clients, when
I am feeling an emotional reaction in the session (or in life in general), or when a client is
not engaged or available to the counseling process. In those instances, I tend to rely much
more on the knowledge and tools I have gained through education and experience,
similarly to my participants.
Limitations of the Current Study and Recommendations for Future Research
While such an open topic as intuition does not appear to lend itself well to the
structured nature of a grounded theory approach, a data-based theory did emerge from the
findings. The topic of clinical intuition is in some respects too broad to study using true
grounded theory; however, the initial shaping of the theory on clinical intuition in
counseling sets the stage for further research and refinement on the topic.
Another limitation is my use of constructivism as the theoretical foundation
behind the grounded theory methodology. Grounded theory has positivist roots but can be
approached through a constructivist lens (Charmaz, 2000; Charmaz, 2001; Strauss &
Corbin, 1998). However, at its core, grounded theory is much more positivist than
constructivist. Because the positivism inherent in grounded theory methods and the
theoretical foundation of constructivism are not an ideal match, future research on the
topic of clinical intuition in counseling should be conducted by more closely matching
the methodology to the theoretical foundation.
In qualitative research, the researcher is the analytical tool and as a result,
personal subjectivity of the researcher can influence the analysis. My personal
experiences with clinical intuition in counseling potentially influenced the data collection
and analysis; however, I tried to bracket my subjectivity as much as possible to keep it
from filtering into my research. By stating my subjectivities and personal reflections on
the research process, I hope to increase the trustworthiness and credibility of my data.
Although the theory of clinical intuition in counseling that arose in my study is
intriguing, it needs to be further developed and refined with a wider variety, number, and
type of participants. My sample ended up consisting of mainly white females, with one
white male. It is difficult to determine the trustworthiness of my data in reference to
counselors of more diverse backgrounds (such as gender, race, ethnicity, sexual
orientation, etc.) since they were not included in this study.
A limitation that arose during data collection and analysis was that the time
between the first interviews for both Woody and Katie and the follow-up interviews was
too much too long. Ideally, the follow-up interview would have occurred very soon after
their initial interviews but circumstances did not make that possible. Because of the long
time between interviews, I did not feel the data collected in the follow-ups was as rich as
it could have been if the first interviews had been fresher in their minds. As a result, the
less rich data could have potentially led to theoretical saturation more quickly with less
new, rich data coming in during the follow-up interviews.
In future research, I would continue to study the aspect of counselor experience in
further developing the theory. During the initial stages of my analysis, experience
appeared to play a larger role in the intuitive process in counseling but did not emerge
fully in the final theory. I would want to further study how counselors across different
experience levels make meaning of and use their intuitions with clients. The aspect of the
counseling relationship is another aspect that I would continue to explore in future
research, both in trying to gain a greater understanding of its role in the process and in
how it triggers an intuition in a counselor. This is an important aspect that must be
studied further to gain a wider understanding of the impact of the counseling relationship
variable in making meaning of and using intuition while counseling.
My analysis revealed that counselors' use of intuition can be of great benefit to
the counseling relationship and to the therapeutic progress of a client. By first receiving
and recognizing an intuition and then respectfully communicating it to the client, a
counselor can move her/him toward therapeutic change more quickly and with more
meaning than when their intuitions are not engaged. If using clinical intuition can speed
up the process of helping clients become more mentally "healthy," it should be
incorporated as a valid part of the counseling process, gaining acceptance and recognition
from counselor training programs, licensing boards, and third-party payers.
When their clinical intuition was not engaged in the counseling session, it was
usually a result of something not occurring within the counseling relationship, that is,
some boundary between the counselor and client and their relationship. My research
brings awareness to what kinds of clients or what kinds of emotions "'turn off" clinical
intuition in counselors, hopefully helping intuitive counselors recognize more quickly
when their intuitions were not engaged. Again, as clinical intuition brings great benefit to
the counseling session, it is important that counselors become aware of the instances
when it is not occurring, so they can improve the counseling relationship and therapeutic
progress for their clients.
All participants indicated that they felt their intuitions were correct and when
checked out, clients usually confirmed that the intuition was on target. If an intuition is
usually correct when shared with a client, then it is not faulty thinking or bias as some
critics argue (Gambril, 1990; Hall, 2002; Myers, 2002). It seems that in using the
counseling relationship to trigger intuitions about the client, a counselor is tapping into
some part of the client's reality. How that tapping into process occurs is still a mystery;
however, the result of that process, intuition, is not a mysterious, nebulous thing that we
must avoid at all costs if we are to be considered legitimate. It is something that seems to
greatly facilitate the counseling process.
The participants' meaning of clinical is intuition is similar to but different than
how I have defined it in chapter one: the speedy, unconscious knowing: (a) of
information about a client, (b) used to form hypotheses about a client without rational,
logical means (c) of what sort of treatments will work well with a client, and/or (d) used
to determine a new course of action with a client if feeling 'stuck'.
The participants described a sense of knowing (speedy, unconscious knowing)
about the client (of information about the client), that they communicate to their clients
(testing their intuitive insights/hypotheses about the client). Both Jera and Molly
specifically described using their intuition to help figure out interventions (what sort of
treatments work well). None of the participants described using their clinical intuition to
determine a new course of action with a client if feeling stuck. In fact, most participants
implied that either they did not get stuck with clients very often or that if they did get
stuck, it was because their intuition was not engaged in the session.
My definition did not incorporate an important aspect of clinical intuition that all
participants mentioned in my research: the importance of the counseling relationship in
generating a clinically intuitive insight. Very little of the literature mentions the necessary
rapport, strength and quality of the counseling relationship as generators of clinical
intuition in any discipline (nursing, medicine, business, or counseling). Redding (2001)
did postulate that caring is a basis for empathy and thus intuition in nurses, which is
similar to the idea of the counseling relationship as the basis of intuition, but she
conceptualized it more as qualities within the practitioner and not as a result of the
None of my participants supported the idea that intuition is a form of reflection-
in-action or tacit knowledge (Schiin, 1983; Welsh & Lyons, 2001) or that it was mere
pattern recognition (Benner, 1984/2001; Benner & Tanner, 1987). They all distinguished
between clinical intuition and clinical knowledge in that intuition arises more
spontaneously, without knowing where it came from and knowledge is something that we
learned in our experience or education that we know we are using to generate clinical
ideas. My research indicates that although we primarily gain clinical knowledge with
experience and education, we do not gain more clinical intuition with experience, we just
trust it more.
The nursing literature implies that using intuition to help clients is a skill
practitioners gain with experience; thus, the more exposure they have to certain patterns
of patient behavior and vital signs, the more the nurses will understand how those
patterns fit together quickly. My findings did not support that view of clinical intuition in
counseling. Novice counselors have intuition but do not yet trust using it in session. With
experience, counselors begin to feel more confident and comfortable trusting and using
their clinical intuitions as part of the counseling process.
I believe that beginning counselors do not trust their intuitions because the
counseling field is becoming focused on outcome-based treatments and rigid diagnoses as
we try to gain legitimacy in the scientific and managed care worlds. A novice counselor
might enter a counseling program with strong intuition that can be used to help their
clients in sessions. However, these intuitions may be trained out, as a beginning
counselor learns that they must only use certain proscribed techniques and methods in
counseling a client. With time and experience, intermediate counselors learn to again
trust those clinical intuitions, matching them up with the knowledge and education from
training. Expert counselors have seen the results for many years of bringing their
intuitions back into the sessions that they do so more confidently and comfortably on a
All participants discussed a difference between clinical knowledge, technique,
and intuition in session and all discussed the importance of using both when with a client.
Making meaning out of clinical insight can help move the client to therapeutic change in
a speedy, meaningful way; however, the techniques and clinical knowledge developed in
counseling education, help counselors make sense of how to use their intuitions.